Healthcare Provider Details

I. General information

NPI: 1578636411
Provider Name (Legal Business Name): 34HHA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CENTER CT.
BRIDGEPORT TX
76426
US

IV. Provider business mailing address

P.O. BOX 1298
BRIDGEPORT TX
76426
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-3300
  • Fax: 940-683-3302
Mailing address:
  • Phone: 940-683-3300
  • Fax: 940-683-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number011650
License Number StateTX

VIII. Authorized Official

Name: MRS. KIMBERLY K CANTRELL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 940-683-3300