Provider Demographics
NPI:1558376038
Name:HODGES-TAYLOR HOME CARE INC.
Entity Type:Organization
Organization Name:HODGES-TAYLOR HOME CARE INC.
Other - Org Name:FAMILY CARE HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIGREW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-554-4049
Mailing Address - Street 1:581 PAN AMERICAN DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548
Mailing Address - Country:US
Mailing Address - Phone:254-554-4049
Mailing Address - Fax:254-554-5067
Practice Address - Street 1:581 PAN AMERICAN DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:254-554-4049
Practice Address - Fax:254-554-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003631251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8533OtherCBA VENDOR #
TX0241143-02Medicaid
TX024114302Medicaid
TX0774OtherPHC VENDOR #
TX458428Medicare Oscar/Certification