Provider Demographics
NPI:1932593936
Name:LIFEWAY HOSPICE, LLC
Entity Type:Organization
Organization Name:LIFEWAY HOSPICE, LLC
Other - Org Name:LIFEWAY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILTSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-807-2670
Mailing Address - Street 1:4040 STATE HIGHWAY 121
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-807-2670
Mailing Address - Fax:972-767-0010
Practice Address - Street 1:4040 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 140
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-807-2670
Practice Address - Fax:972-767-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based