Provider Demographics
NPI:1477008977
Name:VAN DYCK HOSPICE ENTERPRISES LLC
Entity Type:Organization
Organization Name:VAN DYCK HOSPICE ENTERPRISES LLC
Other - Org Name:LIFESPRING HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN DYCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:817-249-6800
Mailing Address - Street 1:107 SPROLES DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3213
Mailing Address - Country:US
Mailing Address - Phone:817-249-6800
Mailing Address - Fax:817-249-6802
Practice Address - Street 1:107 SPROLES DR
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-3213
Practice Address - Country:US
Practice Address - Phone:817-249-6800
Practice Address - Fax:817-249-6802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based