Healthcare Provider Details

I. General information

NPI: 1811940844
Provider Name (Legal Business Name): EAST TEXAS CARETEAM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4362 N US HIGHWAY 259
LONGVIEW TX
75605-7674
US

IV. Provider business mailing address

4362 N US HIGHWAY 259
LONGVIEW TX
75605-7674
US

V. Phone/Fax

Practice location:
  • Phone: 903-663-2331
  • Fax: 903-663-4831
Mailing address:
  • Phone: 903-663-2331
  • Fax: 903-663-4831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number005903
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number005903
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number012954
License Number StateTX

VIII. Authorized Official

Name: MRS. MICHELLE JEANETTE SOLIS
Title or Position: OWNER/ADMINISTRATOR
Credential: RN
Phone: 903-663-2331