Healthcare Provider Details

I. General information

NPI: 1386601417
Provider Name (Legal Business Name): CARTER HEALTHCARE OF SAN ANGELO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W CHURCH ST STE 106
LIVINGSTON TX
77351-3242
US

IV. Provider business mailing address

3105 S MERIDIAN AVE
OKLAHOMA CITY OK
73119-1022
US

V. Phone/Fax

Practice location:
  • Phone: 281-241-8264
  • Fax: 281-376-4357
Mailing address:
  • Phone: 405-947-7700
  • Fax: 405-947-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009919
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number009919
License Number StateTX

VIII. Authorized Official

Name: JUSTIN CARTER
Title or Position: AUTHORIZED OFFICIAL/PRESIDENT
Credential:
Phone: 405-947-7700