Provider Demographics
NPI:1679642425
Name:STILL WATERS HOSPICE, LLC
Entity Type:Organization
Organization Name:STILL WATERS HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ZITO
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:318-767-2000
Mailing Address - Street 1:6932 MONROE HWY
Mailing Address - Street 2:
Mailing Address - City:BALL
Mailing Address - State:LA
Mailing Address - Zip Code:71405-3232
Mailing Address - Country:US
Mailing Address - Phone:318-767-2000
Mailing Address - Fax:318-442-5766
Practice Address - Street 1:1405 METRO DR STE L
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3452
Practice Address - Country:US
Practice Address - Phone:318-767-2000
Practice Address - Fax:318-442-5766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1001821Medicaid
LA191636Medicare Oscar/Certification