Provider Demographics
NPI:1558363408
Name:FAMILY CARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:FAMILY CARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-793-4900
Mailing Address - Street 1:4605 TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3028
Mailing Address - Country:US
Mailing Address - Phone:903-793-4900
Mailing Address - Fax:903-792-8412
Practice Address - Street 1:4605 TEXAS BLVD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3028
Practice Address - Country:US
Practice Address - Phone:903-793-4900
Practice Address - Fax:903-792-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006081251E00000X
TX011470251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0240459-01Medicaid
TX458337Medicare UPIN
TX0240459-01Medicaid
TX458337Medicare PIN