MEDICARE: HARBOR HOSPICE OF SOUTHEAST HOUSTON, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency
2	315D00000X	Inpatient Hospice	015201	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	67-1774	OTHER		MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D2051000	OTHER	TX	CLIA ID
2	015201	OTHER	TX	STATE HOSPICE LICENSE

General Provider Information

NPI Number	:	1508116963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR HOSPICE OF SOUTHEAST HOUSTON, LP

Provider Business Mailing Address
First Line	:	3406 COLLEGE ST # 200
Second Line	:	ATTN: LICENSING & CREDENTIALING
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4612
Country	:	US
Telephone Number	:	409-813-2332
Fax Number	:	409-232-0573

Provider Business Practice Location Address
First Line	:	11990 KIRBY DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4860
Country	:	US
Telephone Number	:	713-413-5200
Fax Number	:	713-583-8927

Authorized Official
Title or Position	:	EXEC ADMIN ASSISTANT
Name	:	KAREN CARTER
Credential	:
Telephone Number	:	409-730-2046

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	10/13/2025

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Directions to “HARBOR HOSPICE OF SOUTHEAST HOUSTON, LP ” Practice Location

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