Provider Demographics
NPI:1568802882
Name:CLEARPATH HOSPICE OF FORT WORTH, LLC
Entity Type:Organization
Organization Name:CLEARPATH HOSPICE OF FORT WORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-753-3133
Mailing Address - Street 1:545 W 465 N STE 100
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-8004
Mailing Address - Country:US
Mailing Address - Phone:435-753-3133
Mailing Address - Fax:435-753-3542
Practice Address - Street 1:1164 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6367
Practice Address - Country:US
Practice Address - Phone:435-753-3133
Practice Address - Fax:435-753-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-01
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based