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General NPI Number Information
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NPI Number | 1356448260
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Entity Type | Organization
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Legal Business Name | LAKES AREA HOSPICE, INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 254 ETHEL ST
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City | JASPER
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State | TX
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Zip | 75951-3614
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Country | US
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Telephone | 409-384-5995
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Fax | 409-384-9655
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Provider Business Mailing Address
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Address Line | 254 ETHEL ST
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City | JASPER
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State | TX
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Zip | 75951-3614
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Country | US
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Telephone | 409-384-5995
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Fax | 409-384-9655
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Authorized Official
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Title or Position | CFO
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Name | MS. RAE M TIDWELL
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Credential |
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Telephone | 409-381-1187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 002784
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License Number State | TX
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