NPIMap

Organization Active NPI

Keystone Hospice Care, Inc.

Doing business as Custom Care Hospice

  • Community Based Hospice Care Agency
  • Grapevine, TX
National Provider Identifier
1861620668
Registry record updated May 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
KEYSTONE HOSPICE CARE, INC.
Doing business as
Custom Care Hospice
Practice address
4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389
Phone
(972) 242-5959
Fax
(214) 320-2683
NPI assigned
Jun 30, 2009
Last updated
May 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X TX Primary

Addresses

Primary practice location

4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389

Mailing address

4811 Merlot Ave Unit 110
Grapevine, TX 76051-7389
Phone (972) 242-5959

Other names 1

  • Custom Care Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100310000256 TX Part A Provider - Hospice 5193860567 Practice locations: Grapevine, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861620668. Details of each certification follow.

Hospice certification: CCN 451635

Legal name
KEYSTONE HOSPICE CARE, INC.
Doing business as
CUSTOM CARE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 18, 1995
Last certification
Aug 10, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
4811 Merlot Ave
Unit 110
Grapevine, TX 76051-7389

Care Compare: Hospice

Medicare Care Compare
Listed as
Custom Care HospiceCCN 451635 · All quality measures
Ownership
For-Profit
Certified
Dec 18, 1995
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D0910274Keystone Hospice Care, Inc4811 Merlot Ave Suite 110, Grapevine, TX 76051Certificate of waiverJan 2, 2028

National Provider Directory

National Provider Directory

Locations

2525 Centerville Rd
Dallas, TX 75228
Phone (214) 327-4503

4811 Merlot Ave
Unit 110
Grapevine, TX 76051
Phone (817) 756-8800

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Jun 29, 2009 100%
Brent Mills Individual Corporate OfficerTreasurer Apr 10, 2026
Lanaya Hill Individual W-2 Managing EmployeeAd; Mar 24, 2026
Brent Guerisoli Individual Corporate DirectorDirector and Sole Board Member Jun 9, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2019 100%
John J Gochnour Individual Corporate OfficerPresident Apr 23, 2024
Amber Tueller Individual Corporate OfficerSecretary Apr 23, 2024
Mark Allen Sanders Individual Contracted Managing EmployeeMD; May 22, 2017

Owners & managing parties with NPI records 1

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

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748476800000",
    "number": "1861620668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4811 MERLOT AVE UNIT 110",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517389",
            "telephone_number": "972-242-5959",
            "fax_number": "214-320-2683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 MERLOT AVE UNIT 110",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760517389",
            "telephone_number": "972-242-5959",
            "fax_number": "214-320-2683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEYSTONE HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2025-05-29",
        "certification_date": "2025-05-29",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Care Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Care Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grapevine, TX

Sources for this page

Verify at the official NPI Registry.