Provider Demographics
NPI:1144732389
Name:AMIBALE HOSPICE LLC
Entity type:Organization
Organization Name:AMIBALE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUDIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-234-7285
Mailing Address - Street 1:1123 ARUM
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-2356
Mailing Address - Country:US
Mailing Address - Phone:409-234-7285
Mailing Address - Fax:
Practice Address - Street 1:1123 ARUM
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-2356
Practice Address - Country:US
Practice Address - Phone:409-234-7285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNAMedicaid
NAOtherNA
TXNAOtherNA