Healthcare Provider Details

I. General information

NPI: 1477739225
Provider Name (Legal Business Name): WCG HENDERSON HOME HEALTH CARE SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 FAIR PARK DR. SUITE 103
HENDERSON TX
75654
US

IV. Provider business mailing address

702 FAIR PARK DR SUITE 103
HENDERSON TX
75654
US

V. Phone/Fax

Practice location:
  • Phone: 903-657-7285
  • Fax: 903-657-3027
Mailing address:
  • Phone: 903-657-7285
  • Fax: 903-657-3027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BURT ALLEN KING
Title or Position: CFO
Credential:
Phone: 903-657-8969