Healthcare Provider Details

I. General information

NPI: 1194012740
Provider Name (Legal Business Name): HARBOR HOSPICE OF EAST TEXAS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 FM 777
JASPER TX
75951
US

IV. Provider business mailing address

PO BOX 12686
BEAUMONT TX
77726-2686
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-3662
  • Fax: 409-384-4152
Mailing address:
  • Phone: 409-730-2006
  • Fax: 409-813-2340

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 K CARTER
Title or Position: EXEC ADMIN ASST
Credential:
Phone: 409-730-2046