Provider Demographics
NPI:1356690028
Name:HEART TO HEART HOSPICE OF THE GULF COAST LLC
Entity Type:Organization
Organization Name:HEART TO HEART HOSPICE OF THE GULF COAST LLC
Other - Org Name:HEART TO HEART HOSPICE OF THE GULF COAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-517-6300
Mailing Address - Street 1:7240 CHASE OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-5901
Mailing Address - Country:US
Mailing Address - Phone:972-517-6300
Mailing Address - Fax:972-517-6301
Practice Address - Street 1:550 FANNIN ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3100
Practice Address - Country:US
Practice Address - Phone:979-480-0303
Practice Address - Fax:979-480-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001020869Medicaid
671577Medicare Oscar/Certification