Provider Demographics
NPI:1235410598
Name:WATERFORD HOSPICE LLC
Entity Type:Organization
Organization Name:WATERFORD HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-785-4900
Mailing Address - Street 1:420 N. COLLEGIATE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-3458
Mailing Address - Country:US
Mailing Address - Phone:903-785-1800
Mailing Address - Fax:903-784-6658
Practice Address - Street 1:420 N COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-3464
Practice Address - Country:US
Practice Address - Phone:903-785-1800
Practice Address - Fax:903-784-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671740Medicare Oscar/Certification