Provider Demographics
NPI:1558463406
Name:JOURNEY HOSPICE OF DALLAS, LLC
Entity Type:Organization
Organization Name:JOURNEY HOSPICE OF DALLAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-3043
Mailing Address - Street 1:815 EXOCET DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2255
Mailing Address - Country:US
Mailing Address - Phone:901-937-3030
Mailing Address - Fax:901-937-3049
Practice Address - Street 1:7929 BROOKRIVER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4900
Practice Address - Country:US
Practice Address - Phone:214-920-9980
Practice Address - Fax:214-920-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451750Medicare ID - Type Unspecified