Provider Demographics
NPI:1881968618
Name:HARBOR HOSPICE OF VICTORIA LP
Entity type:Organization
Organization Name:HARBOR HOSPICE OF VICTORIA LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-730-2046
Mailing Address - Street 1:3406 COLLEGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4612
Mailing Address - Country:US
Mailing Address - Phone:409-813-2332
Mailing Address - Fax:409-232-0573
Practice Address - Street 1:5606 N NAVARRO ST STE 209
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1758
Practice Address - Country:US
Practice Address - Phone:361-579-7120
Practice Address - Fax:361-333-1749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014870251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014870OtherTXDADS
TX001026901Medicaid