Provider Demographics
NPI:1508427121
Name:SUNCREST HOSPICE SAN ANTONIO LLC
Entity Type:Organization
Organization Name:SUNCREST HOSPICE SAN ANTONIO LLC
Other - Org Name:SUNCREST HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-849-0486
Mailing Address - Street 1:9800 S MONROE ST STE 809
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4419
Mailing Address - Country:US
Mailing Address - Phone:801-849-0486
Mailing Address - Fax:801-849-0476
Practice Address - Street 1:911 CENTRAL PKWY N STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5053
Practice Address - Country:US
Practice Address - Phone:830-637-2721
Practice Address - Fax:801-849-0476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based