Harbor Hospice of Liberty LP
Organization Active NPI Community Based Hospice Care Agency · Liberty, TX
NPI 1962799528 · NPPES record last updated Nov 23, 2020
Key facts
- NPI
- 1962799528
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- HARBOR HOSPICE OF LIBERTY LP
- Practice address
- 623 Main St Ste 2
Liberty, TX 77575-4848 - Phone
- (936) 641-9431
- Fax
- (936) 641-9187
- NPI assigned
- Jul 5, 2011
- Organization subpart
- No
Authorized official
- Name
- Karen Carter
- Title
- Exec Admin Assistant
- Phone
- (409) 730-2046
Owners & managing parties with NPI records 1
-
Qamar U Arfeen, M.D.
Facilities with the same owner 45
Affiliated clinicians 2
-
Satiskumar P Patel, M.D. MBCHB
-
John L Redman, MD
Medicare Care Compare: Hospice
- Listed as
- Harbor Hospice of Liberty LP
- Ownership
- For-Profit
- Certified
- May 29, 2012
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Hospice certification: CCN 671735
- Legal name
- HARBOR HOSPICE OF LIBERTY LP
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 29, 2012
- Last certification
- Nov 18, 2021
- Ownership / control type
- Proprietary - Partnership
- Organization structure
- Partnership · Proprietary
- Incorporated
- Jun 15, 2011 in TX
- Enrollment address
- 623 Main St
Ste 2
Liberty, TX 77575-4848
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Karen Carter |
W-2 Managing Employee | Feb 1, 2019 | |
| Bryan Gaspard |
W-2 Managing Employee | Mar 28, 2011 | |
| Theresa Cousins |
W-2 Managing Employee | Mar 28, 2011 | |
| Arfeen Properties, L.P. |
5% Or Greater Direct Ownership Interest | Mar 28, 2011 | |
| Limited Partnership Interest | Mar 28, 2011 | ||
| HHCS Managers LLC |
General Partnership Interest | Mar 28, 2011 | |
| Qamar U Arfeen |
5% Or Greater Indirect Ownership Interest | Jun 15, 2011 | |
| Limited Partnership Interest | Jun 15, 2011 | ||
| Kelley L Arfeen |
5% Or Greater Indirect Ownership Interest | Jun 15, 2011 | |
| Limited Partnership Interest | Jun 15, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111101000232 | TX | Part a Provider - Hospice | 5092988428 | Practice locations: Liberty, TX |
National Provider Directory
Locations
623 Main St
Ste 2
Liberty, TX 77575
Phone (936) 641-9431
425 Holderrieth Blvd
Ste 205B
Tomball, TX 77375
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
623 Main St Ste 2
Liberty, TX 77575-4848
Mailing address
3406 College St
Suite 200
Beaumont, TX 77701-4612
Phone (409) 813-2332
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 67-1735 | Other | MEDICARE PTAN | |
| 014311 | Other | TX | TXDADS |
| 45D2034839 | Other | TX | CLIA |
NPI Registry JSON
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1606089600000",
"number": "1962799528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3406 COLLEGE ST",
"address_2": "SUITE 200",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777014612",
"telephone_number": "409-813-2332",
"fax_number": "409-838-7598"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "623 MAIN ST STE 2",
"city": "LIBERTY",
"state": "TX",
"postal_code": "775754848",
"telephone_number": "936-641-9431",
"fax_number": "936-641-9187"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HARBOR HOSPICE OF LIBERTY LP",
"organizational_subpart": "NO",
"enumeration_date": "2011-07-05",
"last_updated": "2020-11-23",
"certification_date": "2020-11-23",
"status": "A",
"authorized_official_last_name": "CARTER",
"authorized_official_first_name": "KAREN",
"authorized_official_title_or_position": "EXEC ADMIN ASSISTANT",
"authorized_official_telephone_number": "409-730-2046"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "67-1735",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TXDADS",
"identifier": "014311",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA",
"identifier": "45D2034839",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
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All providers in Liberty, TX · Community Based Hospice Care Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.