Provider Demographics
NPI:1881284636
Name:DIMPLES HOSPICE LLC
Entity type:Organization
Organization Name:DIMPLES HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:IKECHUKWU
Authorized Official - Last Name:IKEMERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-202-7827
Mailing Address - Street 1:8700 COMMERCE PARK DR STE 208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:346-202-7827
Mailing Address - Fax:
Practice Address - Street 1:8700 COMMERCE PARK DR STE 208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:346-202-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based