=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700232170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH TEXAS HOSPICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2016
-----------------------------------------------------
Last Update Date | 05/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3248 WEST HIGHWAY 44
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-661-9701
-----------------------------------------------------
Fax | 361-664-0676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 468
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78333-0468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-661-9701
-----------------------------------------------------
Fax | 361-664-0676
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | VALERIE ESTRADA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 361-661-9701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------