MEDICARE: CCD HOSPICE MP, 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
2	251G00000X	Community Based Hospice Care Agency	017788	TX

General Provider Information

NPI Number	:	1740739234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CCD HOSPICE MP, LLC

Provider Business Mailing Address
First Line	:	201 W 20TH ST STE 101
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W 20TH ST STE 101
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2325
Country	:	US
Telephone Number	:	903-572-3777
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	TRENT CARGILE
Credential	:
Telephone Number	:	903-575-7030

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	03/15/2019

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Directions to “CCD HOSPICE MP, LLC ” Practice Location

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