Provider Demographics
NPI:1376514299
Name:HEART TO HEART HOSPICE OF TYLER LTD
Entity Type:Organization
Organization Name:HEART TO HEART HOSPICE OF TYLER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:O
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:972-517-3610
Practice Address - Street 1:7925 S BROADWAY AVE
Practice Address - Street 2:SUITE 1140
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-5227
Practice Address - Country:US
Practice Address - Phone:903-593-6619
Practice Address - Fax:903-593-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008979251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012602Medicaid
TX1=========2000Medicare UPIN
TX001012602Medicaid