Healthcare Provider Details

I. General information

NPI: 1316917099
Provider Name (Legal Business Name): EAST TEXAS MEDICAL CENTER HOME HEALTH NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

IV. Provider business mailing address

208 LAFAYETTE ST
PITTSBURG TX
75686-1630
US

V. Phone/Fax

Practice location:
  • Phone: 903-856-6554
  • Fax:
Mailing address:
  • Phone: 903-856-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010133
License Number StateTX

VIII. Authorized Official

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