Provider Demographics
NPI:1942547765
Name:CRESTVIEW HOSPICE LLC
Entity Type:Organization
Organization Name:CRESTVIEW HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-238-5334
Mailing Address - Street 1:282 S CAMINO DEL PUEBLO
Mailing Address - Street 2:STE 1B
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5909
Mailing Address - Country:US
Mailing Address - Phone:505-404-8598
Mailing Address - Fax:888-901-3444
Practice Address - Street 1:282 S CAMINO DEL PUEBLO
Practice Address - Street 2:STE 1B
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5909
Practice Address - Country:US
Practice Address - Phone:505-404-8598
Practice Address - Fax:888-901-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based