MEDICARE: SHEKINA GLORY LEGACY HOSPICE AND PALLIATIVE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	251S00000X	Community/Behavioral Health Agency
5	253Z00000X	In Home Supportive Care Agency
6	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center
7	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1407451404
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEKINA GLORY LEGACY HOSPICE AND PALLIATIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	17006 AUDREY ARBOR WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2148
Country	:	US
Telephone Number	:	318-497-0654
Fax Number	:

Provider Business Practice Location Address
First Line	:	17006 AUDREY ARBOR WAY
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2148
Country	:	US
Telephone Number	:	318-497-0654
Fax Number	:	832-284-7845

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	IRENE CHE
Credential	:
Telephone Number	:	318-497-0654

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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