Healthcare Provider Details

I. General information

NPI: 1225284896
Provider Name (Legal Business Name): OUTREACH HEALTH COMMUNITY CARE SERVICES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 RENNER PARKWAY
RICHARDSON TX
75080
US

IV. Provider business mailing address

251 RENNER PKWY
RICHARDSON TX
75080-1316
US

V. Phone/Fax

Practice location:
  • Phone: 972-840-7219
  • Fax: 972-792-6739
Mailing address:
  • Phone: 972-840-7360
  • Fax: 972-792-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007339
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA L WILLIAMS
Title or Position: CCD - PROJECT MANAGER
Credential:
Phone: 972-840-7360