Provider Demographics
NPI:1336117472
Name:ALLEGIANCE HOME HEALTH OF SOUTHEAST TEXAS
Entity Type:Organization
Organization Name:ALLEGIANCE HOME HEALTH OF SOUTHEAST TEXAS
Other - Org Name:ALLEGIANCE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DARRELL
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-729-6500
Mailing Address - Street 1:3225 LAKE ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7618
Mailing Address - Country:US
Mailing Address - Phone:409-729-6500
Mailing Address - Fax:409-729-6501
Practice Address - Street 1:3225 LAKE ARTHUR DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7618
Practice Address - Country:US
Practice Address - Phone:409-729-6500
Practice Address - Fax:409-729-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009224251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1994824Medicaid
HH406HOtherBLUE CROSS BLUE SHIELD
TX1994824Medicaid