MEDICARE: TRICARE HOSPICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency
2	251G00000X	Community Based Hospice Care Agency		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073829479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICARE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	25673 HIGHWAY 105 W
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77328-2973
Country	:	US
Telephone Number	:	281-358-8000
Fax Number	:	281-358-7999

Provider Business Practice Location Address
First Line	:	25673 HIGHWAY 105 W
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77328-2973
Country	:	US
Telephone Number	:	281-358-8000
Fax Number	:	281-358-7999

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRANDI TRAHAN
Credential	:
Telephone Number	:	281-358-8000

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	03/07/2018

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Directions to “TRICARE HOSPICE, LLC ” Practice Location

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