Provider Demographics
NPI:1538318753
Name:DOS FRONTERAS, LLC
Entity Type:Organization
Organization Name:DOS FRONTERAS, LLC
Other - Org Name:MAVERICK HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:830-757-1362
Mailing Address - Street 1:2822 N VETERANS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-6697
Mailing Address - Country:US
Mailing Address - Phone:830-757-1362
Mailing Address - Fax:830-757-4336
Practice Address - Street 1:2822 N VETERANS BLVD STE B
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-6697
Practice Address - Country:US
Practice Address - Phone:830-757-1362
Practice Address - Fax:830-757-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010575251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671598Medicare PIN