Provider Demographics
NPI:1235121484
Name:AUTUMN JOURNEY HOSPICE, INC.
Entity Type:Organization
Organization Name:AUTUMN JOURNEY HOSPICE, INC.
Other - Org Name:AUTUMN JOURNEY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-233-0525
Mailing Address - Street 1:5347 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-3009
Mailing Address - Country:US
Mailing Address - Phone:972-233-0525
Mailing Address - Fax:072-233-0553
Practice Address - Street 1:5347 SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-3009
Practice Address - Country:US
Practice Address - Phone:972-233-0525
Practice Address - Fax:072-233-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009696251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-1503Medicare ID - Type UnspecifiedHOME HEALTH HOSPICE AGENC