Provider Demographics
NPI:1083980718
Name:ENVISION HOSPICE
Entity Type:Organization
Organization Name:ENVISION HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-450-4306
Mailing Address - Street 1:730 E GRUBB DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-7502
Mailing Address - Country:US
Mailing Address - Phone:214-450-4306
Mailing Address - Fax:972-285-7296
Practice Address - Street 1:730 E GRUBB DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7502
Practice Address - Country:US
Practice Address - Phone:214-450-4306
Practice Address - Fax:972-285-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based