1790282945 NPI number — GILEAD COMMUNITY HOME HEALTH INC

Table of content: (NPI 1790282945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790282945 NPI number — GILEAD COMMUNITY HOME HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILEAD COMMUNITY HOME HEALTH 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:
Provider Other Organization Name Type Code:
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:
1790282945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2104 ROOSEVELT DR STE M
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALWORTHINGTON GARDENS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76013-5900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-801-7100
Provider Business Mailing Address Fax Number:
817-801-7101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2104 ROOSEVELT DR
Provider Second Line Business Practice Location Address:
SUITE M
Provider Business Practice Location Address City Name:
DALWORTHINGTON GARDENS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76013-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-801-7100
Provider Business Practice Location Address Fax Number:
817-801-7101
Provider Enumeration Date:
04/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KORTE
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
913-579-8741

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010817 . This is a "TEXAS HHSC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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