Heritage Hospice of Texarkana LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

012655 Issued in TX

Legal business name

HERITAGE HOSPICE OF TEXARKANA LLC

Practice address

4605 Texas Blvd
Texarkana, TX 75503-3028

Phone

(903) 792-0716

Fax

(903) 792-0719

NPI assigned

Feb 13, 2008

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Blake Rich

Title

Owner, Ceo

Phone

(903) 792-0716

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689842536. Details of each certification follow.

• CCN 671646 Hospice · Active · Details

Hospice certification: CCN 671646

Legal name

HERITAGE HOSPICE OF TEXARKANA LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 30, 2009

Last certification

Nov 18, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Enrollment address

4605 Texas Blvd
Texarkana, TX 75503-3028

Listed as

Heritage Hospice of Texarkana LLCCCN 671646 · All quality measures

Ownership

For-Profit

Certified

Dec 30, 2009

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

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

• Randy Alan Jackson, M.D.

  • Internal Medicine Physician
  • Texarkana, TX
  • NPI 1689832768

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 3

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

• Christian Ferrer, MD

  • Family Medicine Physician
  • Quitman, TX
  • NPI 1376077164

  Hospice

  Care Compare affiliation
• Randy Alan Jackson, M.D.

  • Internal Medicine Physician
  • Texarkana, TX
  • NPI 1689832768

  Hospice

  Care Compare affiliation
• Edward Timothy Okelley, MD

  • Family Medicine Physician
  • Atlanta, TX
  • NPI 1184630212

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689842536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 TEXAS BLVD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033028",
            "telephone_number": "903-792-0716",
            "fax_number": "903-792-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 TEXAS BLVD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033028",
            "telephone_number": "903-792-0716",
            "fax_number": "903-792-0719"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 Church St",
            "address_purpose": "LOCATION",
            "city": "Sulphur Springs",
            "state": "TX",
            "postal_code": "754822161",
            "country_code": "US",
            "telephone_number": "903-307-2300",
            "fax_number": "903-508-4982",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 S Washington Ave",
            "address_purpose": "LOCATION",
            "city": "Marshall",
            "state": "TX",
            "postal_code": "756705300",
            "country_code": "US",
            "telephone_number": "903-665-8828",
            "fax_number": "903-665-8890",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "904 W Main St",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "TX",
            "postal_code": "755513430",
            "country_code": "US",
            "telephone_number": "903-799-7736",
            "fax_number": "903-799-7738",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HERITAGE HOSPICE OF TEXARKANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "BLAKE",
        "authorized_official_title_or_position": "OWNER, CEO",
        "authorized_official_telephone_number": "903-792-0716"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "012655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001018745",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hayden N Hemphill, MD
• Julie Sloan Henderson, APRN
• Shonda Sharee Henley, COTA
• Richard Hennessey, CRNA
• Rosalyn Charmane Henry, DPT
• Heritage Wellness, LLC (Heritage Palliative Care)
• Alaina Leigh Hernandez, FNP-C
• Chelsey Hernandez, OTD, OTR
• Lauren Brooke Hernandez, O.D.
• John Matt Hester, CRNA

• Community Based Hospice Care Agency in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.