Provider Demographics
NPI:1558966879
Name:CENTENNIAL HOSPICE LLC
Entity Type:Organization
Organization Name:CENTENNIAL HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-758-0017
Mailing Address - Street 1:3620 N.JOSEY LANE ,SUITE #114
Mailing Address - Street 2:3620 N.JOSEY LANE ,SUITE #114
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007
Mailing Address - Country:US
Mailing Address - Phone:214-794-2646
Mailing Address - Fax:469-758-0011
Practice Address - Street 1:3620 N.JOSEY LANE ,SUITE #114
Practice Address - Street 2:3620 N.JOSEY LANE ,SUITE #114
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007
Practice Address - Country:US
Practice Address - Phone:214-794-2646
Practice Address - Fax:469-758-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based