Provider Demographics
NPI:1699072504
Name:RIVER CITY HOSPICE OF TEXAS, LLC
Entity type:Organization
Organization Name:RIVER CITY HOSPICE OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:R
Authorized Official - Last Name:MONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-201-5540
Mailing Address - Street 1:PO BOX 20595
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0595
Mailing Address - Country:US
Mailing Address - Phone:409-833-2800
Mailing Address - Fax:409-838-1152
Practice Address - Street 1:6523 MOSS OAK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4221
Practice Address - Country:US
Practice Address - Phone:210-858-9138
Practice Address - Fax:210-568-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001021231Medicaid
TX014112OtherSTATE LICENSE
TX001021231Medicaid