Provider Demographics
NPI:1134114010
Name:GREATER HOSPICE OF TEXAS, INC.
Entity Type:Organization
Organization Name:GREATER HOSPICE OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-753-3494
Mailing Address - Street 1:PO BOX 9725
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-9725
Mailing Address - Country:US
Mailing Address - Phone:903-753-3494
Mailing Address - Fax:903-753-0988
Practice Address - Street 1:1905 W LOOP 281
Practice Address - Street 2:STE. 81
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2572
Practice Address - Country:US
Practice Address - Phone:903-753-3494
Practice Address - Fax:903-753-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006610163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451690Medicare ID - Type Unspecified