Provider Demographics
NPI:1891156030
Name:FOREST GATE HOSPICE, INC.
Entity Type:Organization
Organization Name:FOREST GATE HOSPICE, INC.
Other - Org Name:BRIGHT STAR HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KOMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDHU
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:214-470-4790
Mailing Address - Street 1:5045 LORIMAR DR STE 240
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5743
Mailing Address - Country:US
Mailing Address - Phone:972-403-0448
Mailing Address - Fax:972-403-0453
Practice Address - Street 1:5045 LORIMAR DR STE 240
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5743
Practice Address - Country:US
Practice Address - Phone:972-403-0448
Practice Address - Fax:972-403-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017631Medicaid