Healthcare Provider Details

I. General information

NPI: 1730365818
Provider Name (Legal Business Name): OUTREACH HEALTH COMMUNITY CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 RENNER PKWY
RICHARDSON TX
75080-1316
US

IV. Provider business mailing address

251 RENNER PKWY
RICHARDSON TX
75080-1316
US

V. Phone/Fax

Practice location:
  • Phone: 512-692-7834
  • Fax: 972-792-6739
Mailing address:
  • Phone: 512-692-7834
  • Fax: 972-792-6739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007810
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA WILLIAMS
Title or Position: CORPORATE LEGAL MANAGER
Credential:
Phone: 512-692-7834