Provider Demographics
NPI:1386664159
Name:HEART TO HEART HOSPICE OF SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:HEART TO HEART HOSPICE OF SAN ANTONIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:O
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-517-6300
Mailing Address - Street 1:7240 CHASE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5901
Mailing Address - Country:US
Mailing Address - Phone:972-517-6300
Mailing Address - Fax:972-517-6301
Practice Address - Street 1:1000 CENTRAL PKWY N
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5050
Practice Address - Country:US
Practice Address - Phone:210-824-4113
Practice Address - Fax:210-824-4994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012563251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016807Medicaid
TX001016807Medicaid