Healthcare Provider Details

I. General information

NPI: 1962799528
Provider Name (Legal Business Name): HARBOR HOSPICE OF LIBERTY LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 MAIN ST STE 2
LIBERTY TX
77575-4848
US

IV. Provider business mailing address

3406 COLLEGE ST SUITE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 936-641-9431
  • Fax: 936-641-9187
Mailing address:
  • Phone: 409-813-2332
  • Fax: 409-838-7598

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: 409-730-2046