Provider Demographics
NPI:1023099355
Name:HOUSTON HOSPICE
Entity type:Organization
Organization Name:HOUSTON HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:V
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-677-7138
Mailing Address - Street 1:1905 HOLCOMBE BLVD
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4123
Mailing Address - Country:US
Mailing Address - Phone:713-467-7423
Mailing Address - Fax:713-677-7115
Practice Address - Street 1:1905 HOLCOMBE BLVD
Practice Address - Street 2:BUSINESS OFFICE
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4123
Practice Address - Country:US
Practice Address - Phone:713-467-7423
Practice Address - Fax:713-677-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX315D00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000207900Medicaid
TX451530Medicare ID - Type UnspecifiedPROVIDER NUMBER