Provider Demographics
NPI:1174504708
Name:HOSPICE IN THE PINES INC
Entity Type:Organization
Organization Name:HOSPICE IN THE PINES INC
Other - Org Name:HOSPICE IN THE PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEMETRESS
Authorized Official - Middle Name:LASHEL
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, DAPA, BSW-LSW
Authorized Official - Phone:936-632-1514
Mailing Address - Street 1:1504 W FRANK AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3314
Mailing Address - Country:US
Mailing Address - Phone:936-632-1514
Mailing Address - Fax:936-632-1582
Practice Address - Street 1:1504 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3314
Practice Address - Country:US
Practice Address - Phone:936-632-1514
Practice Address - Fax:936-632-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002060251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000202900Medicaid
TX451537Medicare ID - Type UnspecifiedPROVIDER NUMBER