Provider Demographics
NPI:1558564336
Name:EAST TEXAS PHC, LLC
Entity Type:Organization
Organization Name:EAST TEXAS PHC, LLC
Other - Org Name:PREMIER HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-753-2273
Mailing Address - Street 1:823 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5414
Mailing Address - Country:US
Mailing Address - Phone:903-753-2273
Mailing Address - Fax:
Practice Address - Street 1:823 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5414
Practice Address - Country:US
Practice Address - Phone:903-753-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011536OtherTDH LICENSE
TX011536OtherTDH LICENSE