MEDICARE: EH HEALTH HOSPICE OF THE SOUTHWEST, 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	:	1699516369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EH HEALTH HOSPICE OF THE SOUTHWEST, LLC

Provider Business Mailing Address
First Line	:	6688 N CENTRAL EXPY STE 1300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-3950
Country	:	US
Telephone Number	:	214-239-6500
Fax Number	:	214-239-6581

Provider Business Practice Location Address
First Line	:	8801 JEFFERSON STREET NE
Second Line	:	BUILDING A, SUITE 102A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-2439
Country	:	US
Telephone Number	:	505-594-4956
Fax Number	:	505-814-6828

Authorized Official
Title or Position	:	EVP OF HOME HEALTH OPERATIONS
Name	:	JULIE DIANE JOLLEY
Credential	:
Telephone Number	:	214-239-6500

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	01/02/2025

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