Provider Demographics
NPI:1437597150
Name:FAIRMONT HOSPICE LLC
Entity type:Organization
Organization Name:FAIRMONT HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDHU
Authorized Official - Middle Name:
Authorized Official - Last Name:KURUP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-434-2670
Mailing Address - Street 1:300 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3109
Mailing Address - Country:US
Mailing Address - Phone:888-846-7742
Mailing Address - Fax:888-251-8801
Practice Address - Street 1:300 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3109
Practice Address - Country:US
Practice Address - Phone:888-846-7742
Practice Address - Fax:888-251-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care