MEDICARE: HOSPICE OF THE WEST, LP

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	009414	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	009414	OTHER	TX	TEXAS DAD LICENSE NUMBER

General Provider Information

NPI Number	:	1932181914
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF THE WEST, LP

Provider Business Mailing Address
First Line	:	1950 S LAS VEGAS TRL
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-3350
Country	:	US
Telephone Number	:	817-246-7377
Fax Number	:	817-887-4887

Provider Business Practice Location Address
First Line	:	1950 S LAS VEGAS TRL
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-3350
Country	:	US
Telephone Number	:	817-246-7377
Fax Number	:	817-887-4887

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. GINA MARIE ANDRES
Credential	:	LCSW
Telephone Number	:	949-282-5948

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	08/22/2020

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Directions to “HOSPICE OF THE WEST, LP ” Practice Location

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