Provider Demographics
NPI:1477919298
Name:ROCKWAL HOSPICE INC
Entity Type:Organization
Organization Name:ROCKWAL HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:214-929-7614
Mailing Address - Street 1:10935 ESTATE LN
Mailing Address - Street 2:SUITE S 400 D
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2316
Mailing Address - Country:US
Mailing Address - Phone:972-288-2706
Mailing Address - Fax:972-288-2707
Practice Address - Street 1:10935 ESTATE LN
Practice Address - Street 2:SUITE S 400 D
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2316
Practice Address - Country:US
Practice Address - Phone:972-288-2706
Practice Address - Fax:972-288-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based