Provider Demographics
NPI:1366712978
Name:TRADITIONS HOSPICE OF MADISONVILLE, LLC
Entity type:Organization
Organization Name:TRADITIONS HOSPICE OF MADISONVILLE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:KLEMENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-704-6547
Mailing Address - Street 1:150 4TH AVE N STE 2300
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-2466
Mailing Address - Country:US
Mailing Address - Phone:979-704-6547
Mailing Address - Fax:
Practice Address - Street 1:600E LOOP 304
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835
Practice Address - Country:US
Practice Address - Phone:936-545-0320
Practice Address - Fax:936-545-0296
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRADITIONS HEALTH CARE HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-12
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014808OtherSTATE LICENSE
TX001026499Medicaid
TX014808OtherSTATE LICENSE