Provider Demographics
NPI:1114516705
Name:LENITY LIGHT HOSPICE - DALLAS, LLC
Entity Type:Organization
Organization Name:LENITY LIGHT HOSPICE - DALLAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUTOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-854-3424
Mailing Address - Street 1:3306 WENDOVER CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3248
Mailing Address - Country:US
Mailing Address - Phone:469-757-1600
Mailing Address - Fax:469-519-0202
Practice Address - Street 1:5802 WATAUGA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3069
Practice Address - Country:US
Practice Address - Phone:817-406-1500
Practice Address - Fax:817-928-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based