Provider Demographics
NPI:1538458633
Name:NORTHEAST TEXAS HOME HEALTH AGENCY LTD
Entity Type:Organization
Organization Name:NORTHEAST TEXAS HOME HEALTH AGENCY LTD
Other - Org Name:VITALCARING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-787-7609
Mailing Address - Street 1:8150 N CENTRAL EXPY STE 1800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1883
Mailing Address - Country:US
Mailing Address - Phone:469-839-3777
Mailing Address - Fax:469-983-2083
Practice Address - Street 1:1616 AZALEA DR STE 101
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-2772
Practice Address - Country:US
Practice Address - Phone:254-751-1600
Practice Address - Fax:254-751-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1079251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457159Medicare Oscar/Certification