MEDICARE: NEW AGE HOSPICE PALLIATIVE, 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	253Z00000X	In Home Supportive Care Agency
2	251G00000X	Community Based Hospice Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	019594	OTHER	TX	LICENSE
2	971606	OTHER	TX	ACHC

General Provider Information

NPI Number	:	1881248441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW AGE HOSPICE PALLIATIVE, LLC

Provider Business Mailing Address
First Line	:	2200 SPACE PARK DR STE 405
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3680
Country	:	US
Telephone Number	:	832-369-6970
Fax Number	:	866-355-7913

Provider Business Practice Location Address
First Line	:	2200 SPACE PARK DR STE 405
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3680
Country	:	US
Telephone Number	:	832-369-6970
Fax Number	:	866-355-7913

Authorized Official
Title or Position	:	CCO
Name	:	SUSAN MARBERRY
Credential	:
Telephone Number	:	903-390-4040

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	01/13/2026

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