Provider Demographics
NPI:1417026527
Name:HOMEBOUND HOSPICE INC
Entity type:Organization
Organization Name:HOMEBOUND HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-544-8788
Mailing Address - Street 1:2251 COUNTRY CLUB DR.
Mailing Address - Street 2:SUITE123
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4766
Mailing Address - Country:US
Mailing Address - Phone:817-745-9816
Mailing Address - Fax:682-418-3446
Practice Address - Street 1:2251 COUNTRY CLUB DR.
Practice Address - Street 2:SUITE123
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4766
Practice Address - Country:US
Practice Address - Phone:817-745-9816
Practice Address - Fax:682-418-3446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006257251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000218900Medicaid