Provider Demographics
NPI:1417026527
Name:HOMEBOUND HOSPICE, INC.
Entity Type:Organization
Organization Name:HOMEBOUND HOSPICE, INC.
Other - Org Name:MAIN STREET HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-444-7992
Mailing Address - Street 1:450 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-2933
Mailing Address - Country:US
Mailing Address - Phone:817-444-7992
Mailing Address - Fax:817-444-7768
Practice Address - Street 1:450 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2933
Practice Address - Country:US
Practice Address - Phone:817-444-7992
Practice Address - Fax:817-444-7768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006257251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX451687Medicare Oscar/Certification