Provider Demographics
NPI:1013901719
Name:ANGEL HEART HOSPICE, LLC
Entity Type:Organization
Organization Name:ANGEL HEART HOSPICE, LLC
Other - Org Name:NEW CENTURY HOSPICE OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-664-2876
Mailing Address - Street 1:P.O. BOX 4060 ATTN: REGULATORY
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4060
Mailing Address - Country:US
Mailing Address - Phone:704-664-2876
Mailing Address - Fax:704-664-1306
Practice Address - Street 1:9430 RESEARCH BLVD
Practice Address - Street 2:BLDG. II, #100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6586
Practice Address - Country:US
Practice Address - Phone:512-342-8288
Practice Address - Fax:512-342-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010299121Medicaid
TX001013622Medicaid
TX001029921Medicaid