MEDICARE: GARDENDALE 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	11204	TX

General Provider Information

NPI Number	:	1679695597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDENDALE HOSPICE LLC

Provider Business Mailing Address
First Line	:	4101 MCEWEN RD STE 260
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	214-357-9200
Fax Number	:	214-357-9202

Provider Business Practice Location Address
First Line	:	4101 MCEWEN RD STE 260
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5112
Country	:	US
Telephone Number	:	214-357-9200
Fax Number	:	214-357-9202

Authorized Official
Title or Position	:	CEO / PRESIDENT & ADMINISTRATOR
Name	:	JESUS MANUEL BARRAGAN
Credential	:	ADMINISTRATOR
Telephone Number	:	214-357-9200

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	03/17/2018

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Directions to “GARDENDALE HOSPICE LLC ” Practice Location

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