Quiet Waters Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

QUIET WATERS HOSPICE, LLC

Practice address

10707 Corporate Dr Ste 114
Stafford, TX 77477-4001

Phone

(346) 901-4272

Fax

(832) 225-3194

NPI assigned

Feb 25, 2022

Last updated

Jul 7, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Coretta Savoy Stevens, RN

Title

Owner/Administrator

Phone

(346) 901-4272

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336895598. Details of each certification follow.

• CCN A91584 Hospice · Active · Details

Hospice certification: CCN A91584

Legal name

QUIET WATERS HOSPICE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Mar 15, 2023

Last certification

Feb 28, 2023

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Jan 28, 2022 in TX

Enrollment address

10707 Corporate Dr
Ste 114
Stafford, TX 77477-4001

Listed as

Quiet Waters Hospice LLCCCN A91584 · All quality measures

Certified

Mar 15, 2023

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Quratulain Hayat, DO

  • Family Medicine Physician
  • Rosenberg, TX
  • NPI 1275013237

  Contracted Managing Employee

  CMS ownership
• Richard Andres Pedroza, M.D.

  • Family Medicine Physician
  • Tomball, TX
  • NPI 1528402823

  Contracted Managing Employee

  CMS ownership
• Tisha Willis, FNP

  • Family Nurse Practitioner
  • Minneapolis, MN
  • NPI 1275175069

  W-2 Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Richard Andres Pedroza, M.D.

  • Family Medicine Physician
  • Tomball, TX
  • NPI 1528402823
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1336895598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13135 SUNRISE CREEK LN",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774987475",
            "telephone_number": "346-901-4272",
            "fax_number": "832-225-3194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10707 CORPORATE DR STE 114",
            "city": "STAFFORD",
            "state": "TX",
            "postal_code": "774774001",
            "telephone_number": "346-901-4272",
            "fax_number": "832-225-3194"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13135 Sunrise Creek Ln",
            "address_purpose": "LOCATION",
            "city": "Sugar Land",
            "state": "TX",
            "postal_code": "774987475",
            "country_code": "US",
            "telephone_number": "346-901-4272",
            "fax_number": "832-225-3194",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "QUIET WATERS HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "CORETTA",
        "authorized_official_middle_name": "SAVOY",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "346-901-4272",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.