Provider Demographics
NPI:1558772905
Name:MY OWN HOSPICE LLC
Entity Type:Organization
Organization Name:MY OWN HOSPICE LLC
Other - Org Name:OPUSCARE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROQUE-VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-591-1606
Mailing Address - Street 1:6900 SW 80TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4931
Mailing Address - Country:US
Mailing Address - Phone:305-591-1606
Mailing Address - Fax:305-591-1618
Practice Address - Street 1:8207 CALLAGHAN RD STE 400A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4735
Practice Address - Country:US
Practice Address - Phone:210-988-1461
Practice Address - Fax:210-404-9887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0002X
TX018026251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741589OtherMEDICARE CCN