Provider Demographics
NPI:1558686949
Name:COMMUNITY HEALTH INTEGRATED SERVICES OF TEXAS, INC.
Entity Type:Organization
Organization Name:COMMUNITY HEALTH INTEGRATED SERVICES OF TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TABETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-753-6163
Mailing Address - Street 1:PO BOX 171295
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-1155
Mailing Address - Country:US
Mailing Address - Phone:214-702-4350
Mailing Address - Fax:214-572-7322
Practice Address - Street 1:4758 VETERANS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7104
Practice Address - Country:US
Practice Address - Phone:214-702-4350
Practice Address - Fax:214-572-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013699251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285136202Medicaid
TX285136201Medicaid
TX2851362Medicaid