1003993585 NPI number — HARBOR HOSPICE OF GULF COAST, LP

Table of content: (NPI 1003993585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003993585 NPI number — HARBOR HOSPICE OF GULF COAST, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR HOSPICE OF GULF COAST, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003993585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3406 COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77701-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-813-2332
Provider Business Mailing Address Fax Number:
409-232-0573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 ENTERPRISE BOULEVARD
Provider Second Line Business Practice Location Address:
BUILDING C
Provider Business Practice Location Address City Name:
ROCKPORT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78382-4333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-727-1232
Provider Business Practice Location Address Fax Number:
361-727-1244
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC ADMIN ASST
Authorized Official Telephone Number:
409-730-2046

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X , with the licence number: 67-1572 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001015176 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 014366 . This is a "TEXAS HEALTH AND HUMAN SERVICES" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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