1306477401 NPI number — CROSS STONE HOSPICE, LLC

Table of content: (NPI 1306477401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306477401 NPI number — CROSS STONE HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSS STONE HOSPICE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306477401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 CREEL CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78624-7087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-997-1033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 GEORGE BUSH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77493-1991
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-553-1321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUSEK
Authorized Official First Name:
KRISTOPHER
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
VICE PRESIDENT OF OPERATIONS
Authorized Official Telephone Number:
713-553-1321

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)