NPIMap

Organization Active NPI

Kingfisher Health-Dallas LLC

Doing business as Halcyon Home

  • Community Based Hospice Care Agency
  • Waco, TX
National Provider Identifier
1871269837
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
KINGFISHER HEALTH-DALLAS LLC
Doing business as
Halcyon Home
Practice address
6431 Sanger Ave
Waco, TX 76710-5651
Phone
(512) 815-9009
NPI assigned
Aug 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Authorized official

Name
Tanya Roberts
Title
Administrator
Phone
(512) 796-1130

Specialties & licenses 1

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

Addresses

Primary practice location

6431 Sanger Ave
Waco, TX 76710-5651

Mailing address

8133 Mesa Dr Ste 200
Austin, TX 78759-8655
Phone (512) 815-9009

Other names 1

  • Halcyon Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220712003472 TX Part A Provider - Hospice 7911388608 Practice locations: Waco, TX

Hospice certification: CCN A91525

Legal name
KINGFISHER HEALTH-DALLAS LLC
Doing business as
HALCYON HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 30, 2022
Last certification
Sep 30, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Feb 27, 2020 in TX
Enrollment address
6431 Sanger Ave
Waco, TX 76710-5651

Care Compare: Hospice

Medicare Care Compare
Listed as
Halcyon HomeCCN A91525 · All quality measures
Certified
Sep 30, 2022
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
45D2259710Kingfisher Health-Dallas LLC6431 Sanger Ave Ste 100, Waco, TX 76710Certificate of waiverMay 9, 2028

National Provider Directory

National Provider Directory

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Scott K Fichter Individual Corporate OfficerBoard Member Feb 27, 2020
Amy E Sweet Individual 5% Or Greater Indirect Ownership InterestChief Executive Officer Feb 27, 2020 100%
Corporate OfficerManager, President, Vice President Feb 27, 2020 100%
Ara Marie Webb Individual Corporate OfficerChief Financial Officer Jan 26, 2023
Kingfisher Health Holdings LLC Organization, Austin, TX LLC 5% Or Greater Direct Ownership Interest Feb 27, 2020 100%
Tanya Louise Roberts Individual W-2 Managing EmployeeAd; Jan 27, 2023
Halcyon Home LLC Organization, Austin, TX LLC 5% Or Greater Direct Ownership Interest Feb 27, 2020 100%
Operational/Managerial Control Feb 27, 2020 100%
Rubin M Simon Individual Contracted Managing EmployeeMD; Mar 4, 2024

Owners & managing parties with NPI records 3

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1629331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725580800000",
    "number": "1871269837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8133 MESA DR STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787598655",
            "telephone_number": "512-815-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6431 SANGER AVE",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767105651",
            "telephone_number": "512-815-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGFISHER HEALTH-DALLAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-19",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "512-796-1130"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Halcyon Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Halcyon Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waco, TX

Sources for this page

Verify at the official NPI Registry.