MEDICARE: SILVER HEART 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	:	1164784658
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER HEART HOSPICE LLC

Provider Business Mailing Address
First Line	:	2601 TANDY AVE
Second Line	:	# 800
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2552
Country	:	US
Telephone Number	:	214-893-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 TANDY AVE
Second Line	:	# 800
City	:	FORT WORTH
State	:	TX
Zip	:	76103-2552
Country	:	US
Telephone Number	:	214-893-2689
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. RODERICK C SATUITO
Credential	:	LVN
Telephone Number	:	817-739-4007

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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