Provider Demographics
NPI:1891843660
Name:CROWN HOSPICE LLC
Entity type:Organization
Organization Name:CROWN HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-492-6440
Mailing Address - Street 1:1406 E RED RIVER ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5521
Mailing Address - Country:US
Mailing Address - Phone:361-575-5900
Mailing Address - Fax:361-575-5905
Practice Address - Street 1:1406 E RED RIVER ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5521
Practice Address - Country:US
Practice Address - Phone:361-575-5900
Practice Address - Fax:361-575-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671581Medicare Oscar/Certification