Provider Demographics
NPI:1770837197
Name:ALTUS HOSPICE OF DALLAS, LP
Entity type:Organization
Organization Name:ALTUS HOSPICE OF DALLAS, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-230-8100
Mailing Address - Street 1:11233 SHADOW CREEK PARKWAY
Mailing Address - Street 2:SUITE 313
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7367
Mailing Address - Country:US
Mailing Address - Phone:832-230-8100
Mailing Address - Fax:832-201-7334
Practice Address - Street 1:4560 BELT LINE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4505
Practice Address - Country:US
Practice Address - Phone:972-761-9140
Practice Address - Fax:214-221-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX015727251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027841Medicaid
TX001027841Medicaid