Southlake Hospice Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SOUTHLAKE HOSPICE CARE INC

Practice address

950 E State Highway 114 Ste160 R112
Southlake,, TX 76092

Phone

(972) 427-2110

NPI assigned

Oct 20, 2022

Last updated

Oct 20, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Andy Kechejian

Title

Ceo

Phone

(972) 427-2110

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285351239. Details of each certification follow.

• CCN A91601 Hospice · Active · Details

Hospice certification: CCN A91601

Legal name

SOUTHLAKE HOSPICE CARE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 18, 2023

Last certification

May 5, 2023

Organization structure

CorporationProprietary

Incorporated

Oct 17, 2022 in TX

Enrollment address

8951 Cypress Waters Blvd Ste 160 Office 1078
Dallas, TX 75019

Listed as

Southlake Hospice Care IncCCN A91601 · All quality measures

Certified

May 18, 2023

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1285351239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 E STATE HIGHWAY 114 STE160 R112",
            "city": "SOUTHLAKE,",
            "state": "TX",
            "postal_code": "76092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E STATE HIGHWAY 114 STE160 R112",
            "city": "SOUTHLAKE,",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "972-427-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE HOSPICE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-20",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "KECHEJIAN",
        "authorized_official_first_name": "ANDY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-427-2110"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southlake Group Health, LLC
• Southlake GYN and Wellness Center, PLLC
• Southlake HB ABA Services LLC
• Southlake Health P.C.
• Southlake HK Group Health, LLC
• Southlake Hospitalists LLC
• Southlake Kidney Specialists, PLLC
• Southlake Medical Supplies, Inc.
• Southlake Mhya PLLC (Medrein Health and Aesthetics)
• Southlake Natural Family Wellness, PLLC

• Community Based Hospice Care Agency in Southlake, TX
• Providers in Southlake, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.