Provider Demographics
NPI:1962776955
Name:CIMA HOSPICE OF EAST TEXAS, LLC
Entity type:Organization
Organization Name:CIMA HOSPICE OF EAST TEXAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-234-1866
Mailing Address - Street 1:12400 NETWORK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3362
Mailing Address - Country:US
Mailing Address - Phone:210-562-3271
Mailing Address - Fax:210-562-3303
Practice Address - Street 1:1401 S SAM RAYBURN FWY STE 500A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-8760
Practice Address - Country:US
Practice Address - Phone:940-440-3004
Practice Address - Fax:903-509-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014772251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025858Medicaid
TX001025858Medicaid