Provider Demographics
NPI:1780254235
Name:WATERLOO HOSPICE LLC
Entity type:Organization
Organization Name:WATERLOO HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-383-1045
Mailing Address - Street 1:18568 FORTY SIX PKWY STE 2001
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6878
Mailing Address - Country:US
Mailing Address - Phone:210-712-1990
Mailing Address - Fax:
Practice Address - Street 1:18568 FORTY SIX PKWY STE 2001
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6878
Practice Address - Country:US
Practice Address - Phone:210-712-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based