NPIMap

Organization Active NPI

Harbor Hospice of Beaumont LP

  • Community Based Hospice Care Agency
  • Beaumont, TX
National Provider Identifier
1043264682
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
67-1511 Issued in TX
Legal business name
HARBOR HOSPICE OF BEAUMONT LP
Practice address
2450 North Major Drive
Beaumont, TX 77713-9575
Phone
(409) 840-5640
Fax
(409) 232-0567
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 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 67-1511 TX Primary
Community Based Hospice Care Agency 251G00000X 009979 TX

Addresses

Primary practice location

2450 North Major Drive
Beaumont, TX 77713-9575

Mailing address

Post Office Box 23077
Beaumont, TX 77720-3077
Phone (409) 813-2332

Other identifiers 2

IdentifierTypeStateIssuer
001013914MedicaidTX
009979OtherTXTXDADS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051005000511 TX Part A Provider - Hospice 3072548304 Practice locations: Beaumont, TX

Hospice certification: CCN 671511

Legal name
HARBOR HOSPICE OF BEAUMONT LP
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 7, 2005
Last certification
Mar 10, 2021
Ownership / control type
Proprietary - Partnership
Organization structure
PartnershipProprietary
Incorporated
Jun 17, 2005 in TX
Enrollment address
2450 N Major Dr
Beaumont, TX 77713-9575

Care Compare: Hospice

Medicare Care Compare
Listed as
Harbor Hospice HouseCCN 671511
Ownership
For-Profit
Certified
Nov 7, 2005
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D1046595Harbor Hospice of Beaumont, LP2450 N Major Dr, Beaumont, TX 77713Certificate of waiverOct 12, 2027

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

440 State St
Jasper, TX 75951
Phone (409) 384-3662

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Karen Carter Individual W-2 Managing Employee Feb 1, 2019
Qamar U Arfeen Individual 5% Or Greater Direct Ownership Interest Jun 17, 2005
General Partnership Interest Apr 1, 2010

Owners & managing parties with NPI records 1

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.

Affiliated clinicians 10

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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1043264682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "POST OFFICE BOX 23077",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777203077",
            "telephone_number": "409-813-2332",
            "fax_number": "409-838-7598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 NORTH MAJOR DRIVE",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777139575",
            "telephone_number": "409-840-5640",
            "fax_number": "409-232-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR HOSPICE OF BEAUMONT LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "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": "TX",
            "license": "67-1511",
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "009979",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001013914",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TXDADS",
            "identifier": "009979",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaumont, TX

Sources for this page

Verify at the official NPI Registry.