Provider Demographics
NPI:1093004178
Name:HARBOR HOSPICE OF HOUSTON, LP
Entity Type:Organization
Organization Name:HARBOR HOSPICE OF HOUSTON, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC ADMIN ASSTS
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 # 200
Mailing Address - Street 2:
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 1:1322 SPACE PARK DR STE A194
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3464
Practice Address - Country:US
Practice Address - Phone:281-461-6109
Practice Address - Fax:281-461-6038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14077251G00000X
014077251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01026079Medicaid
TX14077OtherTDADS LICENSE
45D2027431OtherCLIA
67-1745OtherMEDICARE CCN