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General NPI Number Information
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NPI Number | 1194819243
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Entity Type | Organization
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Legal Business Name | WICHITA FALLS TEXAS PRIVATE DUTY CORPORATION
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 4309 JACKSBORO HIGHWAY SUITE G
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City | WICHITA FALLS
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State | TX
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Zip | 76302-2746
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Country | US
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Telephone | 940-322-1677
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Fax | 940-322-8914
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Provider Business Mailing Address
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Address Line | 4309 JACKSBORO HIGHWAY SUITE G
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City | WICHITA FALLS
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State | TX
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Zip | 76302-2746
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Country | US
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Telephone | 940-322-1677
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Fax | 940-322-8914
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Authorized Official
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Title or Position | DIRECTOR BUSINESS OFFICE SUPPORT AU
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Name | LAURIE HOLTSFORD
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Credential |
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Telephone | 615-465-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 011061
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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