Organization Name: | LAKES AREA HOSPICE, INC. |
NPI Number: | 1356448260 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAE M TIDWELL (CFO) |
Mailing Address: | 254 Ethel St Jasper |
State: | TX US |
Postal Code: | 759513614 |
Phone Number: | 4093845995 |
Fax Number: | 4093849655 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251G00000X |
License Number: | 002784 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Hospice Care, Community Based |
Taxonomy Specialization: | |
Taxonomy Definition: |