Provider Demographics
NPI:1760793814
Name:PALLIATIVE PLUS LLC
Entity Type:Organization
Organization Name:PALLIATIVE PLUS LLC
Other - Org Name:PALOMA HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS-GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:469-714-2570
Mailing Address - Street 1:4400 PIEDRAS DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228
Mailing Address - Country:US
Mailing Address - Phone:210-988-1680
Mailing Address - Fax:210-988-1740
Practice Address - Street 1:4400 PIEDRAS DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228
Practice Address - Country:US
Practice Address - Phone:210-988-1680
Practice Address - Fax:210-988-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001028429Medicaid
TX322533601Medicaid