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NPI Code Detail

MEDICARE: GRACE HOSPICE OF FORT WORTH LLC

MEDICARE: GRACE HOSPICE OF FORT WORTH 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
1251G00000XCommunity Based Hospice Care Agency

General Provider Information

NPI Number : 1356598510
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRACE HOSPICE OF FORT WORTH LLC
Provider Business Mailing Address
First Line : 4100 INTERNATIONAL PLZ
Second Line : SUITE 140
City : FORT WORTH
State : TX
Zip : 76109-4820
Country : US
Telephone Number : 817-735-9600
Fax Number : 817-735-4323
Provider Business Practice Location Address
First Line : 4100 INTERNATIONAL PLZ
Second Line : SUITE 140
City : FORT WORTH
State : TX
Zip : 76109-4820
Country : US
Telephone Number : 817-735-9600
Fax Number : 817-735-4323
Authorized Official
Title or Position : CEO
Name : MR. KIRK BENTON WIED
Credential :
Telephone Number : 817-735-9600
Provider Enumeration Date : 08/19/2008
Last Update Date : 06/08/2017

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Directions to “GRACE HOSPICE OF FORT WORTH LLC ” Practice Location

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