Provider Demographics
NPI:1497828669
Name:WISE COUNTY HOME HEALTH
Entity Type:Organization
Organization Name:WISE COUNTY HOME HEALTH
Other - Org Name:ELARA CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE AND PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-4373
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:903-537-8656
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:4102 OLD JACKSBORO HWY STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2747
Practice Address - Country:US
Practice Address - Phone:940-683-6370
Practice Address - Fax:940-683-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017542251E00000X
TX005255251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459238OtherMEDICARE PTAN
TX=========OtherPACIFICARE INSURANCE
TXHH9532OtherBLUE CROSS BLUE SHIELD
TX0838OtherMEDICAID WAIVER VENDOR ID