Provider Demographics
NPI:1487830600
Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, LP
Entity Type:Organization
Organization Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, LP
Other - Org Name:OUTREACH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-538-6689
Mailing Address - Street 1:251 RENNER PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1316
Mailing Address - Country:US
Mailing Address - Phone:214-538-6689
Mailing Address - Fax:972-792-6739
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:BLDG 100, SUITE 1100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-736-1812
Practice Address - Fax:210-737-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007332251E00000X, 251J00000X, 251E00000X, 251E00000X
251X00000X, 253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185463001Medicaid
TX007332OtherHCSSA LICENSE