MEDICARE: BEYONDFAITH HOSPICE OF JACKSBORO, 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		TX

General Provider Information

NPI Number	:	1225422694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYONDFAITH HOSPICE OF JACKSBORO, LLC

Provider Business Mailing Address
First Line	:	604 OAK ST STE 105
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-3070
Country	:	US
Telephone Number	:	940-521-9915
Fax Number	:

Provider Business Practice Location Address
First Line	:	1702 KELL BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-5627
Country	:	US
Telephone Number	:	940-696-8901
Fax Number	:	940-696-8902

Authorized Official
Title or Position	:	OWNER
Name	:	BECKY RICHARDSON
Credential	:	RN, BSN
Telephone Number	:	940-696-8901

Provider Enumeration Date	:	03/24/2015
Last Update Date	:	06/29/2022

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