Provider Demographics
NPI:1659800944
Name:DSE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DSE ENTERPRISES, LLC
Other - Org Name:HEAVENLY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-874-5005
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:LEMING
Mailing Address - State:TX
Mailing Address - Zip Code:78050-0632
Mailing Address - Country:US
Mailing Address - Phone:210-310-5534
Mailing Address - Fax:210-231-0440
Practice Address - Street 1:6323 SOVEREIGN ST STE 187
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5180
Practice Address - Country:US
Practice Address - Phone:210-874-5005
Practice Address - Fax:210-874-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-08
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017362251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020736Medicaid