MEDICARE: SUPER PLUS HOSPICE INC

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	:	1356771752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPER PLUS HOSPICE INC

Provider Business Mailing Address
First Line	:	915 S MAIN ST
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3408
Country	:	US
Telephone Number	:	817-528-1832
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 S MAIN ST
Second Line	:	SUITE C
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3408
Country	:	US
Telephone Number	:	817-528-1832
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. BAIJU G PILLAI
Credential	:
Telephone Number	:	817-528-1832

Provider Enumeration Date	:	11/21/2013
Last Update Date	:	11/21/2013

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