Healthcare Provider Details

I. General information

NPI: 1053471136
Provider Name (Legal Business Name): OUTREACH HEALTH COMMUNITY CARE SERVICES LC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W MCLAIN ST
SEYMOUR TX
76380-2537
US

IV. Provider business mailing address

269 WEST RENNER PARKWAY
RICHARDSON TX
75080
US

V. Phone/Fax

Practice location:
  • Phone: 940-888-5586
  • Fax: 940-888-5743
Mailing address:
  • Phone: 512-692-7834
  • Fax: 512-973-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007336
License Number StateTX

VIII. Authorized Official

Name: MS. JULIE LORRAINE RYON
Title or Position: DIRECTOR OF ADMINISTRATIVE AND SUPP
Credential:
Phone: 512-692-7834