Healthcare Provider Details

I. General information

NPI: 1578085635
Provider Name (Legal Business Name): CIVPLUS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 OLD OMEN RD APT 2202
TYLER TX
75707-2146
US

IV. Provider business mailing address

6760 OLD JACKSONVILLE HWY STE 101
TYLER TX
75703-0566
US

V. Phone/Fax

Practice location:
  • Phone: 903-566-0734
  • Fax: 903-566-2915
Mailing address:
  • Phone: 903-932-1852
  • Fax: 903-566-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number016450
License Number StateTX

VIII. Authorized Official

Name: MISS ROBBIE BROWN
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-566-0734