1871632513 NPI number — NORTHEAST TEXAS HOME HEALTH AGENCY LTD

Table of content: (NPI 1871632513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871632513 NPI number — NORTHEAST TEXAS HOME HEALTH AGENCY LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST TEXAS HOME HEALTH AGENCY LTD
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:
1871632513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8150 N CENTRAL EXPY STE 1800
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:
75206-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-839-3777
Provider Business Mailing Address Fax Number:
469-983-2083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2015 LONGVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75652-5155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-1004
Provider Business Practice Location Address Fax Number:
903-657-2260
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
469-839-3706

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  002875 , 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: HH8314 . This is a "BLUECROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 023843801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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