Provider Demographics
NPI:1891947040
Name:AG HOSPICE LLC
Entity Type:Organization
Organization Name:AG HOSPICE LLC
Other - Org Name:THREE OAKS HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-628-9950
Mailing Address - Street 1:717 N HARWOOD ST STE 550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6540
Mailing Address - Country:US
Mailing Address - Phone:214-628-9951
Mailing Address - Fax:214-389-0976
Practice Address - Street 1:16420 PARK TEN PL STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5299
Practice Address - Country:US
Practice Address - Phone:832-437-2089
Practice Address - Fax:832-437-2090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE OAKS HOSPICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12501251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012501OtherTX DEPT. OF AGING AND DISABILITY SERVICES, HOME & COMMUNITY SUPPORT SERVICES