MEDICARE: THREE OAKS HOSPICE DALLAS INC

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	:	1720648660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE OAKS HOSPICE DALLAS INC

Provider Business Mailing Address
First Line	:	717 N HARWOOD ST STE 550
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-6540
Country	:	US
Telephone Number	:	214-628-9951
Fax Number	:	214-389-0976

Provider Business Practice Location Address
First Line	:	2100 LAKESIDE BLVD STE 250
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4351
Country	:	US
Telephone Number	:	214-628-9090
Fax Number	:	214-628-9091

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	ANDREA BOHANNON
Credential	:
Telephone Number	:	214-628-9950

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	02/13/2026

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