NPIMap

Organization Active NPI

Heart to Heart Hospice of Tyler LTD

  • Community Based Hospice Care Agency
  • Tyler, TX
National Provider Identifier
1376514299
Registry record updated Aug 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
008979 Issued in TX
Legal business name
HEART TO HEART HOSPICE OF TYLER LTD
Practice address
7925 S Broadway Ave
Suite 1140
Tyler, TX 75703-5227
Phone
(903) 593-6619
Fax
(903) 593-6695
NPI assigned
Jan 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2015

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

Authorized official

Name
Mr. Kelly O Mitchell
Title
Ceo
Phone
(972) 517-6300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 008979 TX Primary

Addresses

Primary practice location

7925 S Broadway Ave
Suite 1140
Tyler, TX 75703-5227

Mailing address

7240 Chase Oaks Blvd
Plano, TX 75025-5901
Phone (972) 517-6300

Other identifiers 1

IdentifierTypeStateIssuer
001012602MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040429000059 TX Part A Provider - Hospice 1557358736 Practice locations: Tyler, TX; Palestine, TX
O20231127001665 TX Part B Supplier - Clinic/Group Practice 1557358736 Receives reassigned benefits from 1 practitioner
Practice locations: Tyler, TX

Hospice certification: CCN 451756

Legal name
HEART TO HEART HOSPICE OF TYLER LTD
Doing business as
HEART TO HEART HOSPICE OF TYLER LTD
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 3, 2004
Last certification
Jun 28, 2019
Ownership / control type
Proprietary - Corporation
Organization structure
OtherProprietary
Incorporated
Oct 15, 2003 in TX
Enrollment address
7925S Broadway Ave 1140
Tyler, TX 75703-5227

Care Compare: Hospice

Medicare Care Compare
Listed as
Heart to Heart Hospice of Tyler LTDCCN 451756
Ownership
For-Profit
Certified
Jun 3, 2004
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
45D1024471Heart to Heart Hospice of Tyler LTD7925 S Broadway Ave, Suite 1140, Tyler, TX 75703Certificate of waiverApr 12, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1006 N Mallard St
Palestine, TX 75801
Phone (903) 729-0957

7925 S Broadway Ave
Ste 1140
Tyler, TX 75703
Phone (903) 593-6619

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
Heart to Heart Hospice Holdings LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Dec 28, 2012 100%
John D Clark Individual Contracted Managing EmployeeMD; Apr 15, 2024
H to H Founders, LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Jun 25, 2015 59.83%
Htohh Preferred LLC Organization, Plano, TX LLC 5% Or Greater Indirect Ownership Interest Jun 25, 2015 39.92%
Amy Louise Widman Individual W-2 Managing EmployeeSupervising Nurse Aug 12, 2024
East Texas Medical Couriers and Express Delivery Services, LLC Organization, Plano, TX LLC 5% Or Greater Direct Ownership Interest Jun 25, 2015 100%
Kelly Mitchell Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2016 65.87%
W-2 Managing Employee Jun 27, 2016
Gina Daughtry Individual W-2 Managing EmployeeAd; Apr 18, 2006

Owners & managing parties with NPI records 1

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

Facilities with the same owner 40

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

View all 40

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 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439251200000",
    "number": "1376514299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7240 CHASE OAKS BLVD",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750255901",
            "telephone_number": "972-517-6300",
            "fax_number": "972-517-3610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 S BROADWAY AVE",
            "address_2": "SUITE 1140",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035227",
            "telephone_number": "903-593-6619",
            "fax_number": "903-593-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEART TO HEART HOSPICE OF TYLER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2015-08-11",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-517-6300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "008979",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012602",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.