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General NPI Number Information
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NPI Number | 1932593936
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Entity Type | Organization
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Legal Business Name | LIFEWAY HOSPICE, LLC
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 4040 STATE HIGHWAY 121 SUITE 140
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City | CARROLLTON
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State | TX
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Zip | 75010
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Country | US
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Telephone | 972-807-2670
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Fax | 972-767-0010
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Provider Business Mailing Address
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Address Line | 4040 STATE HIGHWAY 121 SUITE 140
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City | CARROLLTON
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State | TX
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Zip | 75010
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Country | US
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Telephone | 972-807-2670
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Fax | 972-767-0010
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BRANNON WILTSE
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Credential |
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Telephone | 972-807-2670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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