Provider Demographics
NPI:1467045997
Name:GRACEFUL HEART HOSPICE LLC
Entity Type:Organization
Organization Name:GRACEFUL HEART HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-394-6821
Mailing Address - Street 1:3671 BROADWAY BLVD
Mailing Address - Street 2:STE 500-B3
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043
Mailing Address - Country:US
Mailing Address - Phone:214-394-6821
Mailing Address - Fax:214-593-3235
Practice Address - Street 1:3671 BROADWAY BLVD
Practice Address - Street 2:STE 500-B3
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:214-394-6821
Practice Address - Fax:214-593-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-16
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based