Provider Demographics
NPI:1043203458
Name:BEHAVIORAL AND MEDICAL HOMECARE INC
Entity Type:Organization
Organization Name:BEHAVIORAL AND MEDICAL HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ORWIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-828-2603
Mailing Address - Street 1:6333 E MOCKINGBIRD LN
Mailing Address - Street 2:#147-743
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2692
Mailing Address - Country:US
Mailing Address - Phone:214-828-2603
Mailing Address - Fax:214-828-4954
Practice Address - Street 1:5501 BRYAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-8103
Practice Address - Country:US
Practice Address - Phone:214-828-2603
Practice Address - Fax:214-828-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060GTOtherBCBS
TX000783KMedicare ID - Type Unspecified