Provider Demographics
NPI:1053471136
Name:OUTREACH HEALTH COMMUNITY CARE SERVICES LC
Entity type:Organization
Organization Name:OUTREACH HEALTH COMMUNITY CARE SERVICES LC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATIVE AND SUPP
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:RYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-692-7834
Mailing Address - Street 1:269 WEST RENNER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:512-692-7834
Mailing Address - Fax:512-973-8005
Practice Address - Street 1:120 W MCLAIN ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TX
Practice Address - Zip Code:76380-2537
Practice Address - Country:US
Practice Address - Phone:940-888-5586
Practice Address - Fax:940-888-5743
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007336251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000042200OtherDEPT OF DISABILITY AND AGING
TX0000681400OtherDEPT OF DISABILITY AND AGING
TX0000681300OtherDEPT OF DISABILITY AND AGING
TX000042200OtherDEPT OF DISABILITY AND AGING