Provider Demographics
NPI:1275537219
Name:COMMUNITY HEALTHCARE OF TEXAS
Entity Type:Organization
Organization Name:COMMUNITY HEALTHCARE OF TEXAS
Other - Org Name:COMMUNITY HOSPICE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-989-3260
Mailing Address - Street 1:6100 WESTERN PL STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-4662
Mailing Address - Country:US
Mailing Address - Phone:817-870-2795
Mailing Address - Fax:817-878-3717
Practice Address - Street 1:6100 WESTERN PL STE 105
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-4662
Practice Address - Country:US
Practice Address - Phone:817-870-2795
Practice Address - Fax:817-878-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005213251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000201900Medicaid
TX000201900Medicaid
TX451501Medicare Oscar/Certification