Provider Demographics
NPI:1871369389
Name:HOSPICE AT HOME OF TEXAS, LLC
Entity type:Organization
Organization Name:HOSPICE AT HOME OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:BONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-391-4179
Mailing Address - Street 1:1100 NW LOOP 410 STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2254
Mailing Address - Country:US
Mailing Address - Phone:801-391-4179
Mailing Address - Fax:
Practice Address - Street 1:1100 NW LOOP 410 STE 303
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2254
Practice Address - Country:US
Practice Address - Phone:801-391-4179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based