Provider Demographics
NPI:1447501945
Name:PALLIATIVE CARE & INPATIENTS HOSPICE CORPORATION
Entity type:Organization
Organization Name:PALLIATIVE CARE & INPATIENTS HOSPICE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:DESHIELD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-332-7235
Mailing Address - Street 1:10333 HARWIN DR
Mailing Address - Street 2:325
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1545
Mailing Address - Country:US
Mailing Address - Phone:832-332-7235
Mailing Address - Fax:888-767-6398
Practice Address - Street 1:3204 W PARK AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-2024
Practice Address - Country:US
Practice Address - Phone:832-332-7235
Practice Address - Fax:888-767-6398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000251E00000X, 291U00000X, 315D00000X
324500000X
TX385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No251E00000XAgenciesHome Health
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000OtherINPATIENTS HOSPICE
TX00000Medicaid