Provider Demographics
NPI:1528203353
Name:MOCKBRYANT, LLC
Entity Type:Organization
Organization Name:MOCKBRYANT, LLC
Other - Org Name:AGAPE HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-652-3903
Mailing Address - Street 1:510 JUNIPER LN
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:TX
Mailing Address - Zip Code:76706-7432
Mailing Address - Country:US
Mailing Address - Phone:254-717-9696
Mailing Address - Fax:254-881-7497
Practice Address - Street 1:510 JUNIPER LN
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:TX
Practice Address - Zip Code:76706-7432
Practice Address - Country:US
Practice Address - Phone:254-717-9696
Practice Address - Fax:254-881-7497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2009-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based