MEDICARE: JOURNEY HOSPICE OF DALLAS, 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	:	1558463406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOURNEY HOSPICE OF DALLAS, LLC

Provider Business Mailing Address
First Line	:	815 EXOCET DR
Second Line	:	SUITE 107
City	:	CORDOVA
State	:	TN
Zip	:	38018-2255
Country	:	US
Telephone Number	:	901-937-3030
Fax Number	:	901-937-3049

Provider Business Practice Location Address
First Line	:	7929 BROOKRIVER DR
Second Line	:	SUITE 150
City	:	DALLAS
State	:	TX
Zip	:	75247-4900
Country	:	US
Telephone Number	:	214-920-9980
Fax Number	:	214-920-9522

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. PHYLLIS MARTINDALE
Credential	:
Telephone Number	:	901-937-3043

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	02/10/2010

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