Provider Demographics
NPI:1265858591
Name:COOK CHILDRENS HOME HEALTH
Entity Type:Organization
Organization Name:COOK CHILDRENS HOME HEALTH
Other - Org Name:COOK CHILDREN'S HOME HEALTH - AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-303-2409
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-1383
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-5606
Practice Address - Street 1:2225 W BRAKER LN
Practice Address - Street 2:BUILDING 11
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4031
Practice Address - Country:US
Practice Address - Phone:682-885-6294
Practice Address - Fax:682-885-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDREN'S HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX101493335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342688403/CSNMedicaid
TX342688402/CCPMedicaid
TX342688403/CSNMedicaid
TX342688403/CSNMedicaid