Healthcare Provider Details

I. General information

NPI: 1316449044
Provider Name (Legal Business Name): HWATCH OF THE TX PANHANDLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S GOODNIGHT STREET
CLARENDON TX
79226
US

IV. Provider business mailing address

3310 LAMAR AVE STE A
PARIS TX
75460-5024
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-0042
  • Fax:
Mailing address:
  • Phone: 903-905-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number012425
License Number StateTX

VIII. Authorized Official

Name: ERIK DRENNEN
Title or Position: MANAGER
Credential:
Phone: 903-905-4810