1124287628 NPI number — OUTREACH HEALTH COMMUNITY CARE SERVICES LP

Table of content: (NPI 1124287628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124287628 NPI number — OUTREACH HEALTH COMMUNITY CARE SERVICES LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTREACH HEALTH COMMUNITY CARE SERVICES LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OUTREACH HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124287628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 RENNER PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-1316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-538-6689
Provider Business Mailing Address Fax Number:
972-792-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3730-C S GESSNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77063-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-872-4495
Provider Business Practice Location Address Fax Number:
281-872-4560
Provider Enumeration Date:
06/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR OF COMPLIANCE
Authorized Official Telephone Number:
214-538-6689

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 411241901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411935601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3616484-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 413059301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411221101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1855173-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411930701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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