MEDICARE: BHH OF NACOGDOCHES COUNTY AND REGION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043697360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHH OF NACOGDOCHES COUNTY AND REGION, LLC

Provider Business Mailing Address
First Line	:	5000 LEGACY DR STE 360
Second Line	:	SUITE 360
City	:	PLANO
State	:	TX
Zip	:	75024-3116
Country	:	US
Telephone Number	:	972-248-2441
Fax Number	:	972-248-0773

Provider Business Practice Location Address
First Line	:	4928 NORTH ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1878
Country	:	US
Telephone Number	:	936-569-2949
Fax Number	:	936-569-6203

Authorized Official
Title or Position	:	CEO
Name	:	BRADLEY P. LASSITER
Credential	:
Telephone Number	:	972-248-2441

Provider Enumeration Date	:	05/06/2015
Last Update Date	:	05/06/2015

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