MEDICARE: QUIET WATERS HOSPICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1336895598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUIET WATERS HOSPICE, LLC

Provider Business Mailing Address
First Line	:	13135 SUNRISE CREEK LN
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77498-7475
Country	:	US
Telephone Number	:	346-901-4272
Fax Number	:	832-225-3194

Provider Business Practice Location Address
First Line	:	10707 CORPORATE DR STE 114
Second Line	:
City	:	STAFFORD
State	:	TX
Zip	:	77477-4001
Country	:	US
Telephone Number	:	346-901-4272
Fax Number	:	832-225-3194

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	CORETTA SAVOY STEVENS
Credential	:	RN
Telephone Number	:	346-901-4272

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	07/07/2022

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