Provider Demographics
NPI:1467621078
Name:COSMOS HOSPICE OF SAN ANTONIO, LLC
Entity Type:Organization
Organization Name:COSMOS HOSPICE OF SAN ANTONIO, LLC
Other - Org Name:NEW CENTURY HOSPICE OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LEGAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:PO BOX 4060
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4060
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:8207 CALLAGHAN RD STE 353
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4737
Practice Address - Country:US
Practice Address - Phone:210-520-7734
Practice Address - Fax:210-520-7737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013949251G00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019507Medicaid