Provider Demographics
NPI:1285351239
Name:SOUTHLAKE HOSPICE CARE INC
Entity type:Organization
Organization Name:SOUTHLAKE HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:KECHEJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-427-2110
Mailing Address - Street 1:950 E STATE HIGHWAY 114 STE160 R112
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE,
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 E STATE HIGHWAY 114 STE160 R112
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE,
Practice Address - State:TX
Practice Address - Zip Code:76092
Practice Address - Country:US
Practice Address - Phone:972-427-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based