MEDICARE: ASSURASOURCE HOSPICE LTD

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	:	1942221866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSURASOURCE HOSPICE LTD

Provider Business Mailing Address
First Line	:	12700 HILLCREST RD
Second Line	:	SUITE 176
City	:	DALLAS
State	:	TX
Zip	:	75230-2033
Country	:	US
Telephone Number	:	972-233-1010
Fax Number	:	972-233-1099

Provider Business Practice Location Address
First Line	:	12700 HILLCREST RD
Second Line	:	SUITE 258
City	:	DALLAS
State	:	TX
Zip	:	75230-2033
Country	:	US
Telephone Number	:	972-233-1010
Fax Number	:	972-233-1099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JANET L HOUSTON
Credential	:
Telephone Number	:	972-233-1010

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	11/04/2010

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Practice Location Address:

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1326033481 — MRS. BRENDA WEINFELD BLISS M.S.CCC-SLP/A
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1871588939 — HAYLEY CLARE EOFF M.S.CCC-SPP
Practice Location Address:

12700 HILLCREST RD , SUITE 207
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75230-2033

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1053306696 — SHELLY ANNA HOWARD MS.CCC-SLP
Practice Location Address:

12700 HILLCREST RD , SUITE 207
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75230-2033

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1437197951 — NONA LYNN PANKONIEN LCSW
Practice Location Address:

12700 HILLCREST RD , SUITE 176
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1700800638 — MS. ELAINE PERRY MURPHY LCSW,ACSW
Practice Location Address:

12700 HILLCREST RD , SUITE 258
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75230-2033

Practice Phone: 972-233-1010
Practice Fax: 972-233-1099

Directions to “ASSURASOURCE HOSPICE LTD ” Practice Location

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