MEDICARE: VANTAGE CARE HOSPICE INCORPORATED

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	:	1518198738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANTAGE CARE HOSPICE INCORPORATED

Provider Business Mailing Address
First Line	:	9630 LASBURY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-3628
Country	:	US
Telephone Number	:	281-313-1352
Fax Number	:

Provider Business Practice Location Address
First Line	:	9630 LASBURY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-3628
Country	:	US
Telephone Number	:	281-313-1352
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MICHAEL O ANI
Credential	:
Telephone Number	:	832-883-4969

Provider Enumeration Date	:	08/05/2009
Last Update Date	:	05/16/2012

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