Basic Information
| Provider Information | |||||||||
| NPI: | 1437432929 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUEEN CITY HOSPICE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | QUEEN CITY HOSPICE AND PALLIATIVE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6303 COWBOYS WAY STE 600 | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750340329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695358200 | ||||||||
| FaxNumber: | 2053796720 | ||||||||
| Practice Location | |||||||||
| Address1: | 4605 DUKE DR STE 220 | ||||||||
| Address2: | |||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450401553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135104406 | ||||||||
| FaxNumber: | 5136720486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2011 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ENGLISH | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF HOSPICE | ||||||||
| AuthorizedOfficialTelephone: | 2055337216 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 0206HSP | OH | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 0206HSP | 01 | OH | STATE HOSPICE LICENSE | OTHER |