Organization Active NPI

Dierksen of Texarkana Arkansas LLC

Doing business as Dierksen Hospice

Community Based Hospice Care Agency
Texarkana, AR

National Provider Identifier

1104088632

Registry record updated Sep 24, 2026

On this page

Key facts
NPPES NPI Registry
Medicare participation
Care Compare: Hospice
Laboratory certificates & supplier records
National Provider Directory
Ownership & related parties
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Texarkana, AR
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name: DIERKSEN OF TEXARKANA ARKANSAS LLC
Doing business as: Dierksen Hospice
Dierksen Memorial Hospice
Practice address: 4613 Parkway Dr Ste 20
Texarkana, AR 71854-1191
Phone: (870) 773-4353
Fax: (870) 773-4418
NPI assigned: Jun 26, 2008
Last updated: Sep 24, 2026By the provider in NPPES
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Sep 24, 2026

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

Authorized official

Name: Jesse R Moore
Title: Chief Administrative Officer
Phone: (857) 331-6271

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Community Based Hospice Care Agency	251G00000X		NU	Primary

Addresses

Primary practice location

4613 Parkway Dr Ste 20
Texarkana, AR 71854-1191

Mailing address

500 Faulconer Dr Ste 200
Charlottesville, VA 22903-5089
Phone (434) 977-9711

Other identifiers 2

Identifier	Type	State	Issuer
192560747	Medicaid	AR
AR5307	Other	AR	STATE LICENSE

Other names 2

DIERKSEN HOSPICE Doing business as
Dierksen Memorial Hospice Doing business as

Electronic endpoints 1

Type	Endpoint	Use	Affiliation
CONNECT URL	https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service	Other	Ability Network Inc.

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in AR

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20110805000663	AR	Part A Provider - Hospice	7618146713	Practice locations: Texarkana, AR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104088632. Details of each certification follow.

CCN 041572 Hospice · Active · Details

Hospice certification: CCN 041572

Legal name: DIERKSEN OF TEXARKANA ARKANSAS LLC
Doing business as: DIERKSEN HOSPICE
Certification status: Active
Provider type (POS): Hospice
Participating since: May 3, 2005
Last certification: Jun 16, 2022
Ownership / control type: Proprietary - Corporation
Organization structure: LLCProprietary
Incorporated: Apr 5, 2011 in AR
Enrollment address: 4613 Parkway Dr
Ste 20
Texarkana, AR 71854-1142

Care Compare: Hospice

Medicare Care Compare

Listed as: Dierksen Memorial HospiceCCN 041572 · All quality measures
Ownership: For-Profit
Certified: May 3, 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 number	Laboratory	Certificate	Expires
04D2199772	Dierksen Memorial Hospice4613 Parkway Dr, Suite 20, Texarkana, AR 71854	Certificate of waiver	Nov 9, 2026

National Provider Directory

Locations

4613 Parkway Dr
Ste 20
Texarkana, AR 71854
Phone (870) 773-4353

Ownership & related parties

All disclosed owners & managing parties 16

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

Name	Role	Since	Share
THL Equity Fund VIII Investors (Hospice Care), L.P. Organization, Boston, MA For-profit, Private equity company	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	29.16%
Jesse Reo Moore Individual	Corporate OfficerChief Administrative Officer	May 26, 2021
Jesse Reo Moore Individual	W-2 Managing EmployeeChief Administrative Officer	May 26, 2021
Care Hospice, Inc. Organization, Charlottesville, VA Corporation, For-profit	5% Or Greater Direct Ownership Interest	Jan 1, 2014	100%
Thomas H. Lee Equity Fund VIII, L.P. Organization, Boston, MA For-profit, Private equity company	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	15.07%
Thomas H. Lee Parallel Fund VIII, L.P. Organization, Boston, MA For-profit, Private equity company	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	27.44%
Care Hospice Acquisition, Inc. Organization, Boston, MA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	100%
Hospice Care Buyer, Inc. Organization, Boston, MA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	100%
Hospice Care Holdings, L.P. Organization, Boston, MA Holding company, For-profit, Owned by another organization or individual	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	100%
Bart K Valdez Individual	Corporate OfficerCeo	Jan 6, 2025
Bart K Valdez Individual	W-2 Managing EmployeeCeo	Jan 6, 2025
Russell E Mayo Individual	Contracted Managing EmployeeMD;	Feb 1, 2019
Hospice Care Intermediate I, Inc. Organization, Boston, MA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	100%
Emily McCasland Individual	W-2 Managing EmployeeAd;	Oct 31, 2016
Grant Brown Individual	Corporate OfficerCfo	Dec 10, 2021
Grant Brown Individual	W-2 Managing EmployeeExecutive Vice President	Apr 13, 2017
John B Hunter Individual	5% Or Greater Indirect Ownership Interest	Apr 13, 2017	9.42%
Hospice Care Intermediate II, Inc. Organization, Boston, MA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual	5% Or Greater Indirect Ownership Interest	Dec 9, 2020	100%
Dana K Reid Individual	Corporate OfficerSVP Compliance, Regulatory, Privacy	Jan 4, 2025
Dana K Reid Individual	W-2 Managing EmployeeSVP Compliance, Regulatory, Privacy	Jan 4, 2025

Owners & managing parties with NPI records 1

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

Russell Eugene Mayo, MD
- Family Medicine Physician
- Texarkana, AR
- NPI 1568469211
Contracted Managing Employee
CMS ownership

Facilities with the same owner 38

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Lester Dierksen Memorial Hospice LLC

dba Dierksen Hospice
- Community Based Hospice Care Agency
- Hot Springs, AR
- NPI 1730216359
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
All Caring Hospice Cincinnati Dayton LLC

dba Sanctuary Hospice
- Community Based Hospice Care Agency
- Mason, OH
- NPI 1942720388
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
All Caring Hospice, LLC

dba Sanctuary Hospice
- Community Based Hospice Care Agency
- Canfield, OH
- NPI 1952692543
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Alleo Health of Florida LLC

dba Hospice of Florida
- Community Based Hospice Care Agency
- Jacksonville, FL
- NPI 1376240788
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Alliance Hospice LLC

dba Crescent Hospice
- Community Based Hospice Care Agency
- Augusta, GA
- NPI 1043303753
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Alpha Omega Hospice LP

dba Alpha Omega Hospice
- Community Based Hospice Care Agency
- Weatherford, TX
- NPI 1972611143
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Brookhaven Hospice LLC
- Community Based Hospice Care Agency
- Marlborough, MA
- NPI 1730361742
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Brookhaven Hospice of New Hampshire, LLC

dba Brookhaven Hospice
- Community Based Hospice Care Agency
- Bedford, NH
- NPI 1689981193
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Commonwealth Healthcare, LLC

dba Legacy Hospice
- Community Based Hospice Care Agency
- Charlottesville, VA
- NPI 1740430263
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Continuum Care Hospice LLC

dba Continuum Hospice
- Community Based Hospice Care Agency
- Concord, CA
- NPI 1467859900
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Continuum Care of Mass, LLC

dba Continuum Care
- Community Based Hospice Care Agency
- Fall River, MA
- NPI 1134688575
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership
Continuum Care of Rhode Island, LLC
- Community Based Hospice Care Agency
- West Warwick, RI
- NPI 1164948220
Care Hospice Acquisition, Inc., Care Hospice, Inc., Hospice Care Buyer, Inc., Hospice Care Holdings, L.P., Hospice Care Intermediate I, Inc., Hospice Care Intermediate II, Inc., THL Equity Fund VIII Investors (Hospice Care), L.P., Thomas H. Lee Equ
CMS ownership

View all 38

Practitioners & affiliated clinicians

Affiliated clinicians 4

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

Clay Walt Ferguson, MD
- Family Medicine Physician
- Nashville, AR
- NPI 1518962968
Hospice
Care Compare affiliation
Russell Eugene Mayo, MD
- Family Medicine Physician
- Texarkana, AR
- NPI 1568469211
Hospice
Care Compare affiliation
Kevin Henderson O'Sullivan, M.D.
- Family Medicine Physician
- Texarkana, AR
- NPI 1922492859
Hospice
Care Compare affiliation
William H. Kelley, M.D.
- Family Medicine Physician
- Maud, TX
- NPI 1376561647
Hospice
Care Compare affiliation

NPI Registry JSON

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790208000000",
    "number": "1104088632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 FAULCONER DR STE 200",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229035089",
            "telephone_number": "434-977-9711",
            "fax_number": "434-235-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4613 PARKWAY DR STE 20",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718541191",
            "telephone_number": "870-773-4353",
            "fax_number": "870-773-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIERKSEN OF TEXARKANA ARKANSAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-26",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "857-331-6271"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "192560747",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "AR5307",
            "state": "AR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "DIERKSEN HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dierksen Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Texarkana, AR

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.