Provider Demographics
NPI:1902001159
Name:DPM ALLIANCE HOSPICE AGENCY, LLC
Entity Type:Organization
Organization Name:DPM ALLIANCE HOSPICE AGENCY, LLC
Other - Org Name:CHOICE HEALTH AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF GROWTH OFFICER/GOVERNING BODY
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-363-2436
Mailing Address - Street 1:6760 OLD JACKSONVILLE HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0566
Mailing Address - Country:US
Mailing Address - Phone:903-363-9932
Mailing Address - Fax:817-326-2436
Practice Address - Street 1:1125 CYPRESS STATION DR STE D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3055
Practice Address - Country:US
Practice Address - Phone:713-522-0160
Practice Address - Fax:713-524-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010480251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7003726Medicare ID - Type UnspecifiedPROVIDER NUMBER