Provider Demographics
NPI:1407451404
Name:SHEKINA GLORY LEGACY HOSPICE AND PALLIATIVE SERVICES LLC
Entity Type:Organization
Organization Name:SHEKINA GLORY LEGACY HOSPICE AND PALLIATIVE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-497-0654
Mailing Address - Street 1:17006 AUDREY ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2148
Mailing Address - Country:US
Mailing Address - Phone:318-497-0654
Mailing Address - Fax:
Practice Address - Street 1:17006 AUDREY ARBOR WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2148
Practice Address - Country:US
Practice Address - Phone:318-497-0654
Practice Address - Fax:832-284-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment