Provider Demographics
NPI:1578636411
Name:34HHA, INC
Entity Type:Organization
Organization Name:34HHA, INC
Other - Org Name:HOMEHEALTH CARE OF NORTH CENTRAL TEXAS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-683-3300
Mailing Address - Street 1:P.O. BOX 1298
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426
Mailing Address - Country:US
Mailing Address - Phone:940-683-3300
Mailing Address - Fax:940-683-3302
Practice Address - Street 1:401 CENTER CT.
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426
Practice Address - Country:US
Practice Address - Phone:940-683-3300
Practice Address - Fax:940-683-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011650251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2817140-01Medicaid
TX747087Medicare PIN
747087Medicare UPIN