Scenic Healthcare Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SCENIC HEALTHCARE HOSPICE LLC

Doing business as

Texas Life Hospice - Fort Worth

Practice address

1292 FM-157
Suite 110
Mansfield, TX 76063

Phone

(682) 717-7819

Fax

(682) 400-8842

NPI assigned

Aug 23, 2018

Organization subpart

No

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

Authorized official

Name

Steven C Richardson

Title

Ceo

Phone

(682) 717-7819

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Texas Life Hospice - Fort Worth Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 971525

Legal name

SCENIC HEALTHCARE HOSPICE LLC

Doing business as

TEXAS LIFE HOSPICE - FORT WORTH

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 11, 2019

Last certification

Sep 11, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Dec 31, 2018 in TX

Enrollment address

1292 Highway 157 N
Ste 110
Mansfield, TX 76063-1595

Listed as

Texas Life Hospice - Fort WorthCCN 971525 · All quality measures

Ownership

For-Profit

Certified

Sep 11, 2019

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 4

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 1

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

• Juan Carlos Gavalda, M.D.

  • Family Medicine Physician
  • Grand Prairie, TX
  • NPI 1992062160

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Juan Carlos Gavalda, M.D.

  • Family Medicine Physician
  • Grand Prairie, TX
  • NPI 1992062160

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1534982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657843200000",
    "number": "1730660218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 FM-157",
            "address_2": "SUITE 110",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "682-717-7819",
            "fax_number": "682-400-8842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1292 FM-157",
            "address_2": "SUITE 110",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "76063",
            "telephone_number": "682-717-7819",
            "fax_number": "682-400-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCENIC HEALTHCARE HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-23",
        "last_updated": "2022-07-15",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "682-717-7819"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@texaslifehospice.com",
            "affiliation": "N",
            "address_1": "1292 FM-157",
            "address_2": "Suite 110",
            "city": "Mansfield",
            "state": "TX",
            "country_code": "US",
            "postal_code": "76063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Texas Life Hospice - Fort Worth",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Texas Life Hospice - Fort Worth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara a Cantu Corp
• Winfred Sardar, MD
• Phillip Andrew Saunders, D.O.
• Shoaib H Saya, M.D.
• Kelsie Scamp
• Carol Schmidt, LMT
• Karen Raye Schmidt, PT
• Cherica Ann Schober, DPT, PT
• Amy Elizabeth Schoening, D.D.S.
• Stephen Schubert, LPC, LMFT

• Community Based Hospice Care Agency in Mansfield, TX
• Providers in Mansfield, 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 Jul 15, 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.