Provider Demographics
NPI:1952418337
Name:COUNTRY TRAILS HOSPICE,LTD.
Entity Type:Organization
Organization Name:COUNTRY TRAILS HOSPICE,LTD.
Other - Org Name:AUTUMN WOOD HOSPICE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-962-7595
Mailing Address - Street 1:PO BOX 588
Mailing Address - Street 2:
Mailing Address - City:GRAND SALINE
Mailing Address - State:TX
Mailing Address - Zip Code:75140-0588
Mailing Address - Country:US
Mailing Address - Phone:903-962-7597
Mailing Address - Fax:903-962-3406
Practice Address - Street 1:121 E FRANK ST
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-1823
Practice Address - Country:US
Practice Address - Phone:903-962-7597
Practice Address - Fax:903-962-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-1567OtherMEDICARE PROVIDER NUMBER
TX671567Medicare Oscar/Certification