MEDICARE: MERCHANT OF LIGHT HOSPICE 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	:	1902515927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCHANT OF LIGHT HOSPICE LLC

Provider Business Mailing Address
First Line	:	10416 BOLIVAR DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75072-2987
Country	:	US
Telephone Number	:	972-900-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	10416 BOLIVAR DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75072-2987
Country	:	US
Telephone Number	:	972-900-4111
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EMEKA NWOGU
Credential	:	RN
Telephone Number	:	972-900-4111

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	05/30/2023

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