MEDICARE: GRAPEVINE MISSION 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	671699	OTHER		MEDICARE PTAN

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609184118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAPEVINE MISSION HOSPICE, LLC

Provider Business Mailing Address
First Line	:	4101 WESLEY ST STE F1
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	4101 WESLEY ST STE F1
Second Line	:
City	:	GREENVILLE
State	:	TX
Zip	:	75401-5635
Country	:	US
Telephone Number	:	903-537-3400
Fax Number	:	866-878-4266

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	09/17/2010
Last Update Date	:	02/04/2026

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Directions to “GRAPEVINE MISSION HOSPICE, LLC ” Practice Location

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