=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407285596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARBOR HOSPICE OF WACO LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2013
-----------------------------------------------------
Last Update Date | 06/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 N VALLEY MILLS DR STE 306
-----------------------------------------------------
City | WACO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76710-6076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-218-4290
-----------------------------------------------------
Fax | 254-730-7256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3406 COLLEGE ST SUITE 200
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701-4612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-813-2332
-----------------------------------------------------
Fax | 409-232-0573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXEC ADMIN ASSISTANT
-----------------------------------------------------
Name | KAREN CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 409-730-2046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------