Wild Rose Hospice, LLC.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

WILD ROSE HOSPICE, LLC.

Practice address

10101 Harwin Dr Ste 315
Houston, TX 77036-1721

Phone

(866) 247-7681

Fax

(832) 830-8406

NPI assigned

Jan 25, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Emelike AgomoNPI 1659575249

Title

Owner

Phone

(866) 247-7681

Specialties & licenses 1

Addresses

Other names 1

• WILD ROSE HOSPICE Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 971559

Legal name

WILD ROSE HOSPICE LLC

Doing business as

WILD ROSE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 1, 2020

Last certification

May 1, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Jan 23, 2019 in TX

Enrollment address

3731 Heatherbloom Dr
Houston, TX 77045-5603

Listed as

Wild Rose Hospice LLCCCN 971559

Ownership

For-Profit

Certified

May 1, 2020

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Emelike Uchechi Agomo, MD

  • Ophthalmology Physician
  • Houston, TX
  • NPI 1659575249

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership
• Hameed Q Ali, D. O.

  • Internal Medicine Physician
  • Temple, TX
  • NPI 1104974955

  Corporate Director

  CMS ownership

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Emelike Uchechi Agomo, MD

  • Ophthalmology Physician
  • Houston, TX
  • NPI 1659575249
  NPD Authorized official
• Abhaman Parmar, LSA

  • Surgical Physician Assistant
  • Houston, TX
  • NPI 1487772307
  NPD

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

{
    "created_epoch": "1548374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1437613262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 HARWIN DR STE 315",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770361721",
            "telephone_number": "866-247-7681",
            "fax_number": "832-830-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 HARWIN DR STE 315",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770361721",
            "telephone_number": "866-247-7681",
            "fax_number": "832-830-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD ROSE HOSPICE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-25",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "AGOMO",
        "authorized_official_first_name": "EMELIKE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "866-247-7681",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WILD ROSE HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WILD ROSE HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.