Provider Demographics
NPI:1194819243
Name:WICHITA FALLS TEXAS PRIVATE DUTY CORPORATION
Entity Type:Organization
Organization Name:WICHITA FALLS TEXAS PRIVATE DUTY CORPORATION
Other - Org Name:CAREPARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS OFFICE SUPPORT AU
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:4309 JACKSBORO HIGHWAY
Mailing Address - Street 2:SUITE G
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2746
Mailing Address - Country:US
Mailing Address - Phone:940-322-1677
Mailing Address - Fax:940-322-8914
Practice Address - Street 1:4309 JACKSBORO HIGHWAY
Practice Address - Street 2:SUITE G
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2746
Practice Address - Country:US
Practice Address - Phone:940-322-1677
Practice Address - Fax:940-322-8914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011061251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002234Medicaid
TX1001555Medicaid
TX011061OtherSTATE LICENSE
TX1001552Medicaid
TX1769135-01Medicaid