Provider Demographics
NPI:1942254537
Name:OPTUM PALLIATIVE AND HOSPICE CARE
Entity Type:Organization
Organization Name:OPTUM PALLIATIVE AND HOSPICE CARE
Other - Org Name:EVERCARE HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDERLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-221-0793
Mailing Address - Street 1:1009 WINDCROSS CT.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067
Mailing Address - Country:US
Mailing Address - Phone:713-219-6490
Mailing Address - Fax:713-219-6491
Practice Address - Street 1:9702 BISSONNET ST
Practice Address - Street 2:SUITE 2200W
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8001
Practice Address - Country:US
Practice Address - Phone:713-219-6490
Practice Address - Fax:713-219-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671571Medicare PIN
TX273741Medicare PIN