MEDICARE: COVENANT HOSPICE & PALLIATIVE CARE, LP

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	007583	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	007583	OTHER	TX	HCSSA STATE LICENSE #

General Provider Information

NPI Number	:	1396742805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COVENANT HOSPICE & PALLIATIVE CARE, LP

Provider Business Mailing Address
First Line	:	3221 COLLINSWORTH ST
Second Line	:	SUITE 160
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6577
Country	:	US
Telephone Number	:	817-735-8741
Fax Number	:	817-735-8836

Provider Business Practice Location Address
First Line	:	3221 COLLINSWORTH ST
Second Line	:	STE 160
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6577
Country	:	US
Telephone Number	:	817-735-8741
Fax Number	:	817-735-8836

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. DAVID P CAPPER
Credential	:	M.D.
Telephone Number	:	817-735-8741

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/24/2007

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