Organization
COUNTRY TRAILS HOSPICE,LTD.
Active
Other names
Autumn Wood Hospice Care
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN A. MARINICK (PRESIDENT OF THE GENERAL PARTNER)
(903) 962-7595
Entity
Organization
Contact information
Practice address
121 E FRANK ST, GRAND SALINE, TX 75140-1823
(903) 962-7597
(903) 962-3406
Mailing address
PO BOX 588, GRAND SALINE, TX 75140-0588
(903) 962-7597
(903) 962-3406
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67-1567
MEDICARE PROVIDER NUMBER
TX
Enumeration date
08/23/2006
Last updated
02/17/2011
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