Healthcare Provider Details

I. General information

NPI: 1679598569
Provider Name (Legal Business Name): CRAIG HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735A TROUP HWY
TYLER TX
75701-5869
US

IV. Provider business mailing address

PO BOX 121119 DEPT 1119
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-3223
  • Fax: 409-654-2068
Mailing address:
  • Phone: 801-261-7139
  • Fax: 801-288-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KALTRIDER
Title or Position: PRESIDENT
Credential:
Phone: 203-837-2330