Provider Demographics
NPI:1306837893
Name:FOREFRONT LIVING HOSPICE
Entity Type:Organization
Organization Name:FOREFRONT LIVING HOSPICE
Other - Org Name:FAITH HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:JOHNSON-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-413-1566
Mailing Address - Street 1:12477 MERIT DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2344
Mailing Address - Country:US
Mailing Address - Phone:972-239-5300
Mailing Address - Fax:214-355-3950
Practice Address - Street 1:12477 MERIT DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:972-239-5300
Practice Address - Fax:214-355-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
TX315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012621Medicaid