Healthcare Provider Details

I. General information

NPI: 1710986807
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 W COMMERCE ST
FAIRFIELD TX
75840-1406
US

IV. Provider business mailing address

734 W COMMERCE ST
FAIRFIELD TX
75840-1406
US

V. Phone/Fax

Practice location:
  • Phone: 903-389-3504
  • Fax: 903-389-3541
Mailing address:
  • Phone: 903-389-3504
  • Fax: 903-389-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number007375
License Number StateTX

VIII. Authorized Official

Name: MS. TRACI K. ANDERSON
Title or Position: AREA DIRECTOR OF OPERATIONS
Credential:
Phone: 903-535-6056