Provider Demographics
NPI:1225422694
Name:BEYONDFAITH HOSPICE OF JACKSBORO, LLC
Entity Type:Organization
Organization Name:BEYONDFAITH HOSPICE OF JACKSBORO, LLC
Other - Org Name:BEYONDFAITH HOSPICE OF WICHITA FALLS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:940-696-8901
Mailing Address - Street 1:604 OAK ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3070
Mailing Address - Country:US
Mailing Address - Phone:940-521-9915
Mailing Address - Fax:
Practice Address - Street 1:1702 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5627
Practice Address - Country:US
Practice Address - Phone:940-696-8901
Practice Address - Fax:940-696-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based