Provider Demographics
NPI:1992907521
Name:BISHOP HOSPICE, LLC
Entity type:Organization
Organization Name:BISHOP HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHIBU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-770-0597
Mailing Address - Street 1:809 MEADOWSIDE CT
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-3721
Mailing Address - Country:US
Mailing Address - Phone:972-770-0597
Mailing Address - Fax:972-770-0598
Practice Address - Street 1:4402 BROADWAY BLVD STE 14A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-8263
Practice Address - Country:US
Practice Address - Phone:972-770-0597
Practice Address - Fax:972-770-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251G00000X
TX2287251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2287Medicaid
TX2287Medicaid