Provider Demographics
NPI:1639686256
Name:LITTLE LANTERN HOSPICE LLC
Entity Type:Organization
Organization Name:LITTLE LANTERN HOSPICE LLC
Other - Org Name:PEACE VALLEY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-788-8588
Mailing Address - Street 1:2705 DAMSEL BELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-6169
Mailing Address - Country:US
Mailing Address - Phone:469-788-8588
Mailing Address - Fax:469-788-7800
Practice Address - Street 1:4323 N JOSEY LN STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4619
Practice Address - Country:US
Practice Address - Phone:469-775-9555
Practice Address - Fax:469-788-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018790OtherTEXAS HOSPICE LICENSE