Provider Demographics
NPI:1104852540
Name:HOME HOSPICE OF GRAYSON COUNTY
Entity Type:Organization
Organization Name:HOME HOSPICE OF GRAYSON COUNTY
Other - Org Name:HOME HOSPICE OF COOKE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-868-9315
Mailing Address - Street 1:PO BOX 2306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-2306
Mailing Address - Country:US
Mailing Address - Phone:903-868-9315
Mailing Address - Fax:903-893-2772
Practice Address - Street 1:505 W CENTER ST
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-7827
Practice Address - Country:US
Practice Address - Phone:903-868-9315
Practice Address - Fax:903-893-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001861251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000200400Medicaid
TX000200400Medicaid