Provider Demographics
NPI:1578555017
Name:ESSENTIAL HEALTH SYSTEMS, LLC
Entity Type:Organization
Organization Name:ESSENTIAL HEALTH SYSTEMS, LLC
Other - Org Name:COUNTRY STYLE HEALTH CARE OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-465-2626
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-9998
Mailing Address - Country:US
Mailing Address - Phone:903-482-6400
Mailing Address - Fax:903-482-6403
Practice Address - Street 1:250 E. MARSHALL
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-9998
Practice Address - Country:US
Practice Address - Phone:903-482-6400
Practice Address - Fax:903-482-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008292251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1737108Medicaid
679376Medicare Oscar/Certification