Provider Demographics
NPI:1508083858
Name:COMMUNITY CARE HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:COMMUNITY CARE HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVALYNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUDOI
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MBA
Authorized Official - Phone:972-522-8180
Mailing Address - Street 1:1600 E PIONEER PKWY
Mailing Address - Street 2:SUITE 343
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6542
Mailing Address - Country:US
Mailing Address - Phone:972-266-8511
Mailing Address - Fax:972-266-8522
Practice Address - Street 1:1600 E PIONEER PKWY
Practice Address - Street 2:SUITE 343
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6542
Practice Address - Country:US
Practice Address - Phone:972-266-8511
Practice Address - Fax:972-266-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014813251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX301132201Medicaid