Provider Demographics
NPI:1649548967
Name:AUTUMN MIST HOSPICE INC
Entity type:Organization
Organization Name:AUTUMN MIST HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-419-4911
Mailing Address - Street 1:81 TIMBERSPIRE LN
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2894
Mailing Address - Country:US
Mailing Address - Phone:281-419-4911
Mailing Address - Fax:281-419-5141
Practice Address - Street 1:81 TIMBERSPIRE LN
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2894
Practice Address - Country:US
Practice Address - Phone:281-419-4911
Practice Address - Fax:281-419-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based