Provider Demographics
NPI:1164866836
Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, L.P.
Entity Type:Organization
Organization Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, L.P.
Other - Org Name:OUTREACH HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CORPORATE COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RH BSN CPHQ
Authorized Official - Phone:512-750-8520
Mailing Address - Street 1:505 E HUNTLAND DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3717
Mailing Address - Country:US
Mailing Address - Phone:512-750-7520
Mailing Address - Fax:512-973-8005
Practice Address - Street 1:1616 S KENTUCKY ST
Practice Address - Street 2:SUITE 130A
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2252
Practice Address - Country:US
Practice Address - Phone:806-373-0986
Practice Address - Fax:806-373-5128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH HEALTH CARE, INC.,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7335251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185474701Medicaid