Provider Demographics
NPI:1023178423
Name:COUNTRY HOME CARE, INC.
Entity Type:Organization
Organization Name:COUNTRY HOME CARE, INC.
Other - Org Name:COUNTRY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PENDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-427-8366
Mailing Address - Street 1:1505 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75426-3419
Mailing Address - Country:US
Mailing Address - Phone:903-427-8366
Mailing Address - Fax:903-427-8369
Practice Address - Street 1:1505 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75426-3419
Practice Address - Country:US
Practice Address - Phone:903-427-8366
Practice Address - Fax:903-427-8369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010155251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181369301Medicaid