Provider Demographics
NPI:1679859060
Name:ST. GABRIEL'S HOSPICE AND PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:ST. GABRIEL'S HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Name:ST. GABRIEL'S HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-306-4545
Mailing Address - Street 1:1240 FOREST PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087
Mailing Address - Country:US
Mailing Address - Phone:817-306-4545
Mailing Address - Fax:817-887-2704
Practice Address - Street 1:2501 PARKVIEW DR STE 600B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5822
Practice Address - Country:US
Practice Address - Phone:817-306-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-29
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based