Provider Demographics
NPI:1043214638
Name:COMMUNITY HEALTHCARE OF TEXAS
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE OF TEXAS
Other - Org Name:PROVIDENCE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-870-2795
Mailing Address - Street 1:6100 WESTERN PLACE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:817-870-2795
Mailing Address - Fax:817-878-3717
Practice Address - Street 1:6700 SANGER AVENUE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710
Practice Address - Country:US
Practice Address - Phone:254-399-9099
Practice Address - Fax:254-399-8397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007477251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019692Medicaid
TX000201900Medicaid
TX001019692Medicaid