Provider Demographics
NPI:1346509494
Name:KELTON HOSPICE, INC.
Entity Type:Organization
Organization Name:KELTON HOSPICE, INC.
Other - Org Name:HERITAGE HOSPICE OF EAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-792-0716
Mailing Address - Street 1:4605 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3028
Mailing Address - Country:US
Mailing Address - Phone:903-792-0716
Mailing Address - Fax:903-792-0719
Practice Address - Street 1:5070 KINSEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3005
Practice Address - Country:US
Practice Address - Phone:903-218-6870
Practice Address - Fax:903-218-6874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018670251G00000X
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027951Medicaid