Basic Information
| Provider Information | |||||||||
| NPI: | 1043264682 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HARBOR HOSPICE OF BEAUMONT LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | POST OFFICE BOX 23077 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777203077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098132332 | ||||||||
| FaxNumber: | 4098387598 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 NORTH MAJOR DRIVE | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777139575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098405640 | ||||||||
| FaxNumber: | 4092320567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXEC ADMIN ASST | ||||||||
| AuthorizedOfficialTelephone: | 4097302046 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 009979 | TX | N | Agencies | Hospice Care, Community Based | 251G00000X | 67-1511 | TX | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 001013914 | 05 | TX | MEDICAID | 009979 | 01 | TX | TXDADS | OTHER |