Provider Demographics
NPI:1508630864
Name:GOOD LOVE HOSPICE LLC
Entity Type:Organization
Organization Name:GOOD LOVE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WASYHUN
Authorized Official - Middle Name:
Authorized Official - Last Name:TESFAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-922-0750
Mailing Address - Street 1:3008 PRESIDIO CIR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5077
Mailing Address - Country:US
Mailing Address - Phone:469-922-0750
Mailing Address - Fax:
Practice Address - Street 1:3008 PRESIDIO CIR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5077
Practice Address - Country:US
Practice Address - Phone:469-922-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based