Provider Demographics
NPI:1003365099
Name:ANGELIC GRACE HOSPICE AND PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:ANGELIC GRACE HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:ALTA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-546-9522
Mailing Address - Street 1:14140 MIDWAY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3707
Mailing Address - Country:US
Mailing Address - Phone:214-941-9522
Mailing Address - Fax:972-546-4792
Practice Address - Street 1:14140 MIDWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75244-3707
Practice Address - Country:US
Practice Address - Phone:214-941-9522
Practice Address - Fax:972-546-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-02
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based