Basic Information
| Provider Information | |||||||||
| NPI: | 1003993585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR HOSPICE OF GULF COAST, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3406 COLLEGE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098132332 | ||||||||
| FaxNumber: | 4092320573 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 ENTERPRISE BOULEVARD | ||||||||
| Address2: | BUILDING C | ||||||||
| City: | ROCKPORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783824333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3617271232 | ||||||||
| FaxNumber: | 3617271244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC ADMIN ASST | ||||||||
| AuthorizedOfficialTelephone: | 4097302046 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | N | Agencies | Hospice Care, Community Based | 251G00000X | 67-1572 | TX | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 001015176 | 05 | TX | MEDICAID | 014366 | 01 | TX | TEXAS HEALTH AND HUMAN SERVICES | OTHER |