1649493693 NPI number — TEXAS HOME HEALTH SKILLED SERVICES,LP

Table of content: (NPI 1649493693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649493693 NPI number — TEXAS HOME HEALTH SKILLED SERVICES,LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HOME HEALTH SKILLED 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:
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:
1649493693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17855 N DALLAS PKWY
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:
75287-6852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-267-1100
Provider Business Mailing Address Fax Number:
972-267-1115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 W GOODWIN AVE
Provider Second Line Business Practice Location Address:
SUITE 370
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-576-4683
Provider Business Practice Location Address Fax Number:
361-576-1018
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SISCEL
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF LEGAL
Authorized Official Telephone Number:
224-221-0465

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: 1487993-15 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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