Healthcare Provider Details

I. General information

NPI: 1376306498
Provider Name (Legal Business Name): SOUTHEAST TEXAS PROFESSIONAL HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 CROW RD
BEAUMONT TX
77706-6910
US

IV. Provider business mailing address

4347 CROW RD
BEAUMONT TX
77706-6910
US

V. Phone/Fax

Practice location:
  • Phone: 409-212-0205
  • Fax: 409-242-2263
Mailing address:
  • Phone: 409-212-0205
  • Fax: 409-242-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LEANN R RIVERS
Title or Position: ADMINISTRATION
Credential:
Phone: 409-212-0205