=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477787307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUTREACH HEALTH COMMUNITY CARE SERVICES, LC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 08/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3730-C S GESSNER RD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77063-5132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-872-4495
-----------------------------------------------------
Fax | 281-872-4560
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 RENNER PKWY
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-692-7834
-----------------------------------------------------
Fax | 972-792-6739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF COMPLIANCE
-----------------------------------------------------
Name | MS. REBECCA LYNN WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 142-703-1310
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 012140
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------