1144631136 NPI number — CP HOME CARE, LLC

Table of content: (NPI 1144631136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144631136 NPI number — CP HOME CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CP HOME CARE, 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:
Provider Other Organization Name Type Code:
6
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:
1144631136
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:
112 N DIXON ST STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-352-3561
Provider Business Practice Location Address Fax Number:
866-987-4193
Provider Enumeration Date:
05/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LANIER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
CHIEF GROWTH OFFICER
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)

  • Identifier: 3590143 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com