Provider Demographics
NPI:1508042714
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:MS
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 1:10501 GATEWAY BLVD W STE 16
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7934
Practice Address - Country:US
Practice Address - Phone:915-595-8729
Practice Address - Fax:915-595-8990
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
TX007333251E00000X, 251J00000X, 251E00000X, 251E00000X
253Z00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185445701Medicaid
TX007333OtherHCSSA LICENSE
TX185445701OtherEL PASO FIRST CREDENTIALING AND BILLING
TX185445701Medicaid
TX1508042714OtherEL PASO HEALTH CREDENTIALING AND BILLING