Provider Demographics
NPI:1053445668
Name:HARBOR HOSPICE OF AUSTIN LP
Entity Type:Organization
Organization Name:HARBOR HOSPICE OF AUSTIN LP
Other - Org Name:BEACON HOSPICE OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-730-2046
Mailing Address - Street 1:3406 COLLEGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4612
Mailing Address - Country:US
Mailing Address - Phone:409-813-2332
Mailing Address - Fax:409-232-0573
Practice Address - Street 1:7800 SHOAL CREEK BLVD STE 105N
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1098
Practice Address - Country:US
Practice Address - Phone:512-443-7100
Practice Address - Fax:512-443-7109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011306251G00000X
671630251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
671630OtherMEDICARE CCN
TX011306OtherTXDADS
45D1066165OtherCLIA CERTIFICATE OF WAIVER
TX001018868Medicaid
671630Medicare PIN
671630OtherMEDICARE CCN