1578061487 NPI number — EAST TEXAS HOME HEALTH SERVICES LLC

Table of content: (NPI 1578061487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578061487 NPI number — EAST TEXAS HOME HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST TEXAS HOME HEALTH SERVICES LLC
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:
UT HEALTH EAST TEXAS HOME HEALTH SERVICES
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:
1578061487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6760 OLD JACKSONVILLE HWY STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75703-0566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-363-9932
Provider Business Mailing Address Fax Number:
888-333-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 COUNTY ROAD 4114 STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75686-4199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-887-3556
Provider Business Practice Location Address Fax Number:
888-333-8977
Provider Enumeration Date:
01/25/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LANIER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF GROWTH OFFICER/PARTNER
Authorized Official Telephone Number:
903-932-1852

Provider Taxonomy Codes

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

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





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