MEDICARE: GA HOSPICE OF EL PASO, 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	:	1740781707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GA HOSPICE OF EL PASO, LLC

Provider Business Mailing Address
First Line	:	1537 N ZARAGOZA RD STE 2A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8095
Country	:	US
Telephone Number	:	915-594-1116
Fax Number	:	915-849-7825

Provider Business Practice Location Address
First Line	:	1537 N ZARAGOZA RD STE 2A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8095
Country	:	US
Telephone Number	:	915-594-1116
Fax Number	:	915-849-7825

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARGARET IKE
Credential	:
Telephone Number	:	915-594-1116

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	02/26/2018

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