MEDICARE: WILD ROSE HOSPICE, 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

General Provider Information

NPI Number	:	1437613262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILD ROSE HOSPICE, LLC.

Provider Business Mailing Address
First Line	:	10101 HARWIN DR STE 315
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1721
Country	:	US
Telephone Number	:	866-247-7681
Fax Number	:	832-830-8406

Provider Business Practice Location Address
First Line	:	10101 HARWIN DR STE 315
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1721
Country	:	US
Telephone Number	:	866-247-7681
Fax Number	:	832-830-8406

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMELIKE AGOMO
Credential	:
Telephone Number	:	866-247-7681

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	10/21/2021

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