1386820462 NPI number — OUTREACH HEALTH COMMUNITY CARE SERVICES, LP

Table of content: (NPI 1386820462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386820462 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:
1386820462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2019
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:
214-703-1310
Provider Business Mailing Address Fax Number:
972-792-6739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7600 CHEVY CHASE DR STE 450
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78752-1503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-835-6150
Provider Business Practice Location Address Fax Number:
512-339-7906
Provider Enumeration Date:
01/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CORPORATE LEGAL MANAGER
Authorized Official Telephone Number:
214-703-1310

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007810 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000869400 . This is a "REGION 7 CBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".