MEDICARE: SPECIALTY CARE 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

General Provider Information

NPI Number	:	1104656016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY CARE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	21015 BELMONT VILLAGE WAY
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-3193
Country	:	US
Telephone Number	:	346-646-3511
Fax Number	:	346-646-3531

Provider Business Practice Location Address
First Line	:	21015 BELMONT VILLAGE WAY
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77449-3193
Country	:	US
Telephone Number	:	346-646-3511
Fax Number	:	346-646-3531

Authorized Official
Title or Position	:	OWNER
Name	:	LORI CLARK
Credential	:	RN
Telephone Number	:	346-818-4080

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	05/27/2026

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