1922051077 NPI number — HOME HEALTH OF TARRANT COUNTY INC

Table of content: (NPI 1922051077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922051077 NPI number — HOME HEALTH OF TARRANT COUNTY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME HEALTH OF TARRANT COUNTY INC
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:
ELARA CARING
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:
1922051077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 LYNDON B JOHNSON FWY STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-537-8656
Provider Business Mailing Address Fax Number:
903-537-8420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N BEATON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-937-1359
Provider Business Practice Location Address Fax Number:
972-937-1971
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF REGULATORY
Authorized Official Telephone Number:
800-234-1866

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009361 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 011829 , 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: 000657700 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000055200 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023511101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001004095 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10008178 . This is a "AMERIGROUP PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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