Provider Demographics
NPI:1447816087
Name:AUSTIN COMMUNITY HOSPICE, LLC
Entity type:Organization
Organization Name:AUSTIN COMMUNITY HOSPICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-354-7222
Mailing Address - Street 1:223 W ANDERSON LN STE B700
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1237
Mailing Address - Country:US
Mailing Address - Phone:512-374-7222
Mailing Address - Fax:512-362-6464
Practice Address - Street 1:223 W ANDERSON LN STE B700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1237
Practice Address - Country:US
Practice Address - Phone:512-354-7222
Practice Address - Fax:512-362-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001031394Medicaid