Provider Demographics
NPI:1043078504
Name:LONESTAR LEGACY HOSPICE LLC
Entity type:Organization
Organization Name:LONESTAR LEGACY HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-218-5876
Mailing Address - Street 1:5300 TROPICANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-3320
Mailing Address - Country:US
Mailing Address - Phone:915-218-5876
Mailing Address - Fax:915-218-5202
Practice Address - Street 1:9206 MCCOMBS ST STE 33
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-7423
Practice Address - Country:US
Practice Address - Phone:915-218-5876
Practice Address - Fax:915-218-5202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based