Organization
LAKES AREA HOSPICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RAE M TIDWELL (CFO)
(409) 381-1187
Entity
Organization
Contact information
Practice address
254 ETHEL ST, JASPER, TX 75951-3614
(409) 384-5995
(409) 384-9655
Mailing address
254 ETHEL ST, JASPER, TX 75951-3614
(409) 384-5995
(409) 384-9655
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
002784
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HH6800
BCBS OF TEXAS
—
Enumeration date
09/20/2006
Last updated
08/22/2020
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