Provider Demographics
NPI:1679695597
Name:GARDENDALE HOSPICE LLC
Entity Type:Organization
Organization Name:GARDENDALE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT & ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:BARRAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:214-357-9200
Mailing Address - Street 1:4101 MCEWEN RD STE 260
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5112
Mailing Address - Country:US
Mailing Address - Phone:214-357-9200
Mailing Address - Fax:214-357-9202
Practice Address - Street 1:4101 MCEWEN RD STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5112
Practice Address - Country:US
Practice Address - Phone:214-357-9200
Practice Address - Fax:214-357-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11204251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based