Provider Demographics
NPI:1366679284
Name:EAGLE PASS HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:EAGLE PASS HOSPICE CARE, INC.
Other - Org Name:EAGLE PASS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRIZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-773-9999
Mailing Address - Street 1:1858 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4713
Mailing Address - Country:US
Mailing Address - Phone:830-773-9999
Mailing Address - Fax:830-773-8789
Practice Address - Street 1:1858 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4713
Practice Address - Country:US
Practice Address - Phone:830-773-9999
Practice Address - Fax:830-773-8789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN