Provider Demographics
NPI:1073802849
Name:OUTREACH MEDICAL HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:OUTREACH MEDICAL HOME HEALTH AGENCY
Other - Org Name:OUTREACH MEDICAL HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-293-3500
Mailing Address - Street 1:200 BRYAN PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1768
Mailing Address - Country:US
Mailing Address - Phone:972-293-3500
Mailing Address - Fax:972-293-3514
Practice Address - Street 1:200 BRYAN PL
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1768
Practice Address - Country:US
Practice Address - Phone:972-293-3500
Practice Address - Fax:972-293-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012286251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215252200Other1215252200