MEDICARE: TEXAS HOME HEALTH PROVIDER, 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency	017068	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45D2007598	OTHER	TX	CLIA
2	017068	OTHER	TX	TEXAS HCSSA LICENSE

General Provider Information

NPI Number	:	1285964908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS HOME HEALTH PROVIDER, LLC

Provider Business Mailing Address
First Line	:	600 W 6TH ST FL 4
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3684
Country	:	US
Telephone Number	:	214-702-2790
Fax Number	:	415-231-2445

Provider Business Practice Location Address
First Line	:	600 W 6TH ST STE 475
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3684
Country	:	US
Telephone Number	:	214-702-2790
Fax Number	:	415-231-2445

Authorized Official
Title or Position	:	OWNER
Name	:	TAYLOR CAROL
Credential	:
Telephone Number	:	214-702-2790

Provider Enumeration Date	:	12/31/2009
Last Update Date	:	12/05/2023

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Directions to “TEXAS HOME HEALTH PROVIDER, LLC ” Practice Location

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