| Organization Name: | GARDENDALE HOSPICE LLC |
| NPI Number: | 1679695597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN HEATH KEENAN (ADMINISTRATOR CEO) |
| Mailing Address: | 753 W 2nd Ave Corsicana |
| State: | TX US |
| Postal Code: | 751102942 |
| Phone Number: | 9038743232 |
| Fax Number: | 9038743235 |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/09/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 11204 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |