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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251G00000X | Agencies | Hospice Care, Community Based |