Provider Demographics
NPI:1437613262
Name:WILD ROSE HOSPICE, LLC.
Entity type:Organization
Organization Name:WILD ROSE HOSPICE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMELIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-247-7681
Mailing Address - Street 1:10101 HARWIN DR STE 315
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1721
Mailing Address - Country:US
Mailing Address - Phone:866-247-7681
Mailing Address - Fax:832-830-8406
Practice Address - Street 1:10101 HARWIN DR STE 315
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1721
Practice Address - Country:US
Practice Address - Phone:866-247-7681
Practice Address - Fax:832-830-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based