Provider Demographics
NPI:1033465208
Name:GOOD SHEPHERD HOSPICE OF SAN ANTONIO, L.L.C.
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOSPICE OF SAN ANTONIO, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DELESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-943-0903
Mailing Address - Street 1:4350 WILL ROGERS PKWY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73108-1840
Mailing Address - Country:US
Mailing Address - Phone:405-943-0903
Mailing Address - Fax:405-943-0950
Practice Address - Street 1:5811 UNIVERSITY HTS STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4883
Practice Address - Country:US
Practice Address - Phone:210-733-3939
Practice Address - Fax:210-733-3488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026018Medicaid