Provider Demographics
NPI:1245391259
Name:SOUTHEAST TEXAS PROFESSIONAL HEALTH CARE INC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS PROFESSIONAL HEALTH CARE INC
Other - Org Name:PROFESSIONAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-212-0205
Mailing Address - Street 1:2533 CALDER ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1915
Mailing Address - Country:US
Mailing Address - Phone:409-212-0205
Mailing Address - Fax:409-212-0208
Practice Address - Street 1:2533 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1915
Practice Address - Country:US
Practice Address - Phone:409-212-0205
Practice Address - Fax:409-212-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007934251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679157Medicare Oscar/Certification