Provider Demographics
NPI:1134546641
Name:CHARIS HOSPICE LLC.
Entity type:Organization
Organization Name:CHARIS HOSPICE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-932-1852
Mailing Address - Street 1:6760 OLD JACKSONVILLE HIGHWAY
Mailing Address - Street 2:STE 101
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0566
Mailing Address - Country:US
Mailing Address - Phone:903-363-9932
Mailing Address - Fax:817-326-2436
Practice Address - Street 1:3724 EXECUTIVE CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-1638
Practice Address - Country:US
Practice Address - Phone:737-484-0080
Practice Address - Fax:737-484-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741592Medicare PIN