1013268432 NPI number — HARBOR HOSPICE OF SOUTH SAN ANTONIO, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013268432 NPI number — HARBOR HOSPICE OF SOUTH SAN ANTONIO, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR HOSPICE OF SOUTH SAN ANTONIO, LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEACON HOSPICE OF SOUTH SAN ANTONIO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013268432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3406 COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77701-4612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-813-2332
Provider Business Mailing Address Fax Number:
409-232-0573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15714 HUEBNER RD STE 2B2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78248-0996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-481-0500
Provider Business Practice Location Address Fax Number:
210-481-0504
Provider Enumeration Date:
09/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXEC ADMIN ASST
Authorized Official Telephone Number:
409-730-2046

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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