Provider Demographics
NPI:1295148559
Name:GREENLEAF HOSPICE LLC
Entity type:Organization
Organization Name:GREENLEAF HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:ARLEEN
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:682-518-3877
Mailing Address - Street 1:1290 HIGHWAY 157 N
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1538
Mailing Address - Country:US
Mailing Address - Phone:682-518-3877
Mailing Address - Fax:682-518-3879
Practice Address - Street 1:1290 HIGHWAY 157 N
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1538
Practice Address - Country:US
Practice Address - Phone:682-518-3877
Practice Address - Fax:682-518-3879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based