NPIMap

Organization Active NPI

Harbor Hospice of Gulf Coast, LP

  • Community Based Hospice Care Agency
  • Rockport, TX
National Provider Identifier
1003993585
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
67-1572 Issued in TX
Legal business name
HARBOR HOSPICE OF GULF COAST, LP
Practice address
400 Enterprise Boulevard
Building C
Rockport, TX 78382-4333
Phone
(361) 727-1232
Fax
(361) 727-1244
NPI assigned
Nov 1, 2006
Last updated
Apr 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Karen Carter
Title
Exec Admin Asst
Phone
(409) 730-2046

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU
Community Based Hospice Care Agency 251G00000X 67-1572 TX Primary

Addresses

Primary practice location

400 Enterprise Boulevard
Building C
Rockport, TX 78382-4333

Mailing address

3406 College St
Suite 200
Beaumont, TX 77701-4612
Phone (409) 813-2332

Other identifiers 2

IdentifierTypeStateIssuer
014366OtherTXTEXAS HEALTH AND HUMAN SERVICES
001015176MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061127000127 TX Part A Provider - Hospice 7618975822 Practice locations: Rockport, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003993585. Details of each certification follow.

Hospice certification: CCN 671572

Legal name
HARBOR HOSPICE OF GULF COAST, LP
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 26, 2007
Last certification
Jul 22, 2022
Ownership / control type
Proprietary - Partnership
Organization structure
OtherProprietary
Enrollment address
400 Enterprise Blvd
Building C
Rockport, TX 78382-4333

Care Compare: Hospice

Medicare Care Compare
Listed as
Harbor Hospice of Gulf Coast LPCCN 671572 · All quality measures
Ownership
For-Profit
Certified
Apr 26, 2007
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

400 Enterprise Blvd
Ste C
Rockport, TX 78382
Phone (361) 727-1232

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jerome Aston Lee Sang Individual Contracted Managing EmployeeMD; Apr 5, 2017
Rene R Acuna Individual 5% Or Greater Direct Ownership Interest Dec 1, 2006 7%
General Partnership Interest Dec 1, 2006
Sabina Diebel Individual W-2 Managing EmployeeAd; Mar 8, 2021
Karen Carter Individual W-2 Managing Employee Feb 1, 2019
Robert R Low Individual 5% Or Greater Direct Ownership Interest Dec 1, 2006 7%
General Partnership Interest Dec 1, 2006
Edwin S Haun Individual 5% Or Greater Direct Ownership Interest Dec 1, 2006 7%
General Partnership Interest Dec 1, 2006
Qamar U Arfeen Individual 5% Or Greater Direct Ownership Interest Oct 1, 2006 79%
General Partnership Interest Oct 1, 2006
Harbor Healthcare Systems LP Organization, Beaumont, TX Management services company General Partnership Interest Dec 1, 2006

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 11

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1003993585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3406 COLLEGE ST",
            "address_2": "SUITE 200",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014612",
            "telephone_number": "409-813-2332",
            "fax_number": "409-232-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ENTERPRISE BOULEVARD",
            "address_2": "BUILDING C",
            "city": "ROCKPORT",
            "state": "TX",
            "postal_code": "783824333",
            "telephone_number": "361-727-1232",
            "fax_number": "361-727-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR HOSPICE OF GULF COAST, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "EXEC ADMIN ASST",
        "authorized_official_telephone_number": "409-730-2046"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "67-1572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS HEALTH AND HUMAN SERVICES",
            "identifier": "014366",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001015176",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockport, TX

Sources for this page

Verify at the official NPI Registry.