Healthcare Provider Details

I. General information

NPI: 1841839057
Provider Name (Legal Business Name): EAGLE PASS HOSPICE AND PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 ZAMORA MEDICAL CIR STE 4
EAGLE PASS TX
78852-5919
US

IV. Provider business mailing address

152 ZAMORA MEDICAL CIR STE 4
EAGLE PASS TX
78852-5919
US

V. Phone/Fax

Practice location:
  • Phone: 830-213-8122
  • Fax: 830-213-8630
Mailing address:
  • Phone: 830-213-8122
  • Fax: 830-213-8630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM TIPA
Title or Position: ADMINISTRATOR
Credential:
Phone: 830-213-8122