Basic Information
| Provider Information | |||||||||
| NPI: | 1881053643 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELYSIAN HOSPICE HOUSTON LLC | ||||||||
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| OtherOrganizationName: | ELYSIAN HOSPICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2537 GOLDEN BEAR DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750062377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149544114 | ||||||||
| FaxNumber: | 2148800053 | ||||||||
| Practice Location | |||||||||
| Address1: | 11104 W AIRPORT BLVD | ||||||||
| Address2: | SUITE 255B | ||||||||
| City: | STAFFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774773035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813332458 | ||||||||
| FaxNumber: | 2813355539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2016 | ||||||||
| LastUpdateDate: | 08/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | UNDERHILL | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
| AuthorizedOfficialMiddleName: | F. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2149544114 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 315D00000X | APPLIED FOR | TX | N | Nursing & Custodial Care Facilities | Hospice, Inpatient | 251G00000X | APPLIED FOR | TX | Y | Agencies | Hospice Care, Community Based |
No ID Information.