Provider Demographics
NPI:1073671657
Name:RIVERCREST HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:RIVERCREST HOME HEALTH CARE, INC.
Other - Org Name:ELITE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:3131 BELL ST
Practice Address - Street 2:SUITE 211
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-5033
Practice Address - Country:US
Practice Address - Phone:806-356-8911
Practice Address - Fax:806-356-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008237251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158821201Medicaid
TX679259Medicare Oscar/Certification