Provider Demographics
NPI:1710061007
Name:LIBBYS HEALTHCARE MANAGEMENT,INC
Entity Type:Organization
Organization Name:LIBBYS HEALTHCARE MANAGEMENT,INC
Other - Org Name:LIBBYS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZACHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-498-7733
Mailing Address - Street 1:6633 BOULEVARD 26
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1523
Mailing Address - Country:US
Mailing Address - Phone:817-498-7733
Mailing Address - Fax:817-498-7733
Practice Address - Street 1:6633 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-1523
Practice Address - Country:US
Practice Address - Phone:817-498-7733
Practice Address - Fax:817-498-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009177251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-1783Medicare ID - Type Unspecified