Provider Demographics
NPI:1316230139
Name:TRADITIONS HOSPICE OF LONGVIEW, LLC
Entity Type:Organization
Organization Name:TRADITIONS HOSPICE OF LONGVIEW, LLC
Other - Org Name:TRADITIONS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-704-6547
Mailing Address - Street 1:150 4TH AVE N STE 2300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2466
Mailing Address - Country:US
Mailing Address - Phone:979-704-6547
Mailing Address - Fax:
Practice Address - Street 1:4362 N US HWY 259
Practice Address - Street 2:SUITE B
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605
Practice Address - Country:US
Practice Address - Phone:903-663-2331
Practice Address - Fax:903-663-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017972OtherTEXAS DEPT. OF AGING AND DISABILITY SERVICES- LICENSE
TX017972OtherTEXAS DEPT. OF AGING AND DISABILITY SERVICES- LICENSE