MEDICARE: CARTER HEALTHCARE OF CENTRAL TEXAS, 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
2	251E00000X	Home Health Agency	13850	TX

General Provider Information

NPI Number	:	1114097169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARTER HEALTHCARE OF CENTRAL TEXAS, LLC

Provider Business Mailing Address
First Line	:	3105 S MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73119-1022
Country	:	US
Telephone Number	:	405-947-7700
Fax Number	:	405-947-7300

Provider Business Practice Location Address
First Line	:	3435 GREYSTONE DR STE 104A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-2363
Country	:	US
Telephone Number	:	830-625-4837
Fax Number	:	830-625-2194

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/PRESIDENT
Name	:	JUSTIN CARTER
Credential	:
Telephone Number	:	405-947-7700

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/28/2024

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