Provider Demographics
NPI:1275262115
Name:KUSH FOR HOSPICE AND PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:KUSH FOR HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-565-3922
Mailing Address - Street 1:2084 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6229
Mailing Address - Country:US
Mailing Address - Phone:623-565-3922
Mailing Address - Fax:
Practice Address - Street 1:315 W ALABAMA ST STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5177
Practice Address - Country:US
Practice Address - Phone:623-565-3922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based