Organization Active NPI

Homebound Hospice Inc

  • Community Based Hospice Care Agency
  • Mansfield, TX
National Provider Identifier
1417026527
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
006257 Issued in TX
Legal business name
HOMEBOUND HOSPICE INC
Practice address
2251 Country Club Dr.
Suite123
Mansfield, TX 76063-4766
Phone
(817) 745-9816
Fax
(682) 418-3446
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Authorized official

Name
Bradley Coleman
Title
Ceo
Phone
(502) 544-8788

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 006257 TX Primary

Addresses

Primary practice location

2251 Country Club Dr.
Suite123
Mansfield, TX 76063-4766

Mailing address

2251 Country Club Dr.
Suite123
Mansfield, TX 76063-4766
Phone (817) 745-9816

Other identifiers 1

IdentifierTypeStateIssuer
000218900MedicaidTX

Other names 1

  • Cardinal Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060123000722 TX Part A Provider - Hospice 1153345673 Practice locations: Mansfield, TX

Hospice certification: CCN 451687

Legal name
HOMEBOUND HOSPICE INC
Doing business as
CARDINAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 6, 1998
Last certification
Sep 17, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
2251 Country Club Dr
Ste 123
Mansfield, TX 76063-4766

Care Compare: Hospice

Medicare Care Compare
Listed as
Cardinal HospiceCCN 451687
Ownership
For-Profit
Certified
Nov 6, 1998
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

450 W Main St
Azle, TX 76020
Phone (817) 444-7992

2251 Country Club Dr
Ste 123
Mansfield, TX 76063
Phone (817) 745-9816

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Koryan Moye Individual 5% Or Greater Indirect Ownership InterestManaging Member Jan 28, 2025 15%
Corporate Director Jan 28, 2025
Abx IV Solutions LLC Organization, San Antonio, TX LLC 5% Or Greater Indirect Ownership Interest Jan 28, 2025 15%
Jordan Coleman Individual 5% Or Greater Indirect Ownership InterestCoo Jan 28, 2025 20%
Corporate OfficerCoo Jan 28, 2025 20%
Corporate DirectorCoo Jan 28, 2025 20%
W-2 Managing Employee Jan 28, 2025
Sachin S Shrestha Individual 5% Or Greater Indirect Ownership InterestManaging Member Jan 28, 2025 20%
Corporate DirectorManaging Member Jan 28, 2025 20%
Sumeesh Dhawan Individual Contracted Managing EmployeeMD; Jan 28, 2025
Keith Fuchs Individual 5% Or Greater Indirect Ownership InterestManaging Member Jan 28, 2025
Corporate Director Jan 28, 2025 5%
Cardinal Hospice Partners LLC Organization, Mansfield, TX LLC 5% Or Greater Indirect Ownership Interest Jan 28, 2025 100%
Shalini Dhawan Individual 5% Or Greater Indirect Ownership InterestManaging Member Jan 28, 2025 20%
Corporate Director Jan 28, 2025
Bradley Coleman Individual 5% Or Greater Indirect Ownership Interest Jan 28, 2025 20%
Corporate OfficerCeo Jan 28, 2025
Corporate DirectorCeo Jan 28, 2025
W-2 Managing EmployeeAd; Jan 28, 2025
BJSS Hospice LLC Organization, Mansfield, TX LLC 5% Or Greater Direct Ownership Interest Jan 28, 2025 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1417026527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2251 COUNTRY CLUB DR.",
            "address_2": "SUITE123",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634766",
            "telephone_number": "817-745-9816",
            "fax_number": "682-418-3446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2251 COUNTRY CLUB DR.",
            "address_2": "SUITE123",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760634766",
            "telephone_number": "817-745-9816",
            "fax_number": "682-418-3446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMEBOUND HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "502-544-8788"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "006257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000218900",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardinal Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, TX

Sources for this page

Verify at the official NPI Registry.