Healthcare Provider Details

I. General information

NPI: 1285964908
Provider Name (Legal Business Name): TEXAS HOME HEALTH PROVIDER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W 6TH ST STE 475
FORT WORTH TX
76102-3684
US

IV. Provider business mailing address

600 W 6TH ST FL 4
FORT WORTH TX
76102-3684
US

V. Phone/Fax

Practice location:
  • Phone: 214-702-2790
  • Fax: 415-231-2445
Mailing address:
  • Phone: 214-702-2790
  • Fax: 415-231-2445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number017068
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TAYLOR CAROL
Title or Position: OWNER
Credential:
Phone: 214-702-2790