Provider Demographics
NPI:1639679541
Name:PICC PALIATIVE CARE HOSPICE LLC
Entity Type:Organization
Organization Name:PICC PALIATIVE CARE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:LAPUZ
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-276-7388
Mailing Address - Street 1:11111 RICHMOND AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6665
Mailing Address - Country:US
Mailing Address - Phone:281-741-7701
Mailing Address - Fax:281-741-7892
Practice Address - Street 1:11111 RICHMOND AVE STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6665
Practice Address - Country:US
Practice Address - Phone:281-741-7701
Practice Address - Fax:281-741-7892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based