Provider Demographics
NPI:1477209815
Name:NORTHEAST TEXAS HOMECARE LLC
Entity Type:Organization
Organization Name:NORTHEAST TEXAS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-617-9388
Mailing Address - Street 1:100 NE LOOP 286
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-2158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-2158
Practice Address - Country:US
Practice Address - Phone:318-617-9388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SJ HOMECARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory