Provider Demographics
NPI:1811560311
Name:SAN AGUSTIN HOSPICE, LLC
Entity Type:Organization
Organization Name:SAN AGUSTIN HOSPICE, LLC
Other - Org Name:SERENITY HOSPICE OF LAREDO, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-516-2732
Mailing Address - Street 1:1220 SAN AGUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-6307
Mailing Address - Country:US
Mailing Address - Phone:956-704-5096
Mailing Address - Fax:956-441-1732
Practice Address - Street 1:1220 SAN AGUSTIN AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-6307
Practice Address - Country:US
Practice Address - Phone:956-704-5096
Practice Address - Fax:956-441-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based