Healthcare Provider Details

I. General information

NPI: 1861743700
Provider Name (Legal Business Name): HARBOR HOSPICE OF WEST DALLAS-FORT WORTH, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6471 SOUTHWEST BLVD STE B
BENBROOK TX
76132
US

IV. Provider business mailing address

3406 COLLEGE ST SUITE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 817-237-2255
  • Fax: 817-237-2355
Mailing address:
  • Phone: 409-813-2332
  • Fax: 409-232-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREN CARTER
Title or Position: EXEC ADMIN ASSISTANT
Credential:
Phone: 409-813-2332