Provider Demographics
NPI:1619204468
Name:ENNIS TEXAS PHYSICIAN'S CHOICE HOMECARE, LLC
Entity Type:Organization
Organization Name:ENNIS TEXAS PHYSICIAN'S CHOICE HOMECARE, LLC
Other - Org Name:PHYSICIAN'S CHOICE HOMECARE OF ENNIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELAUNTE
Authorized Official - Middle Name:MISHELL
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:972-686-7602
Mailing Address - Street 1:6800 HERITAGE PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8746
Mailing Address - Country:US
Mailing Address - Phone:972-412-9916
Mailing Address - Fax:972-412-9971
Practice Address - Street 1:802 W ENNIS AVE # C
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-3810
Practice Address - Country:US
Practice Address - Phone:972-287-1131
Practice Address - Fax:972-287-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747537Medicare Oscar/Certification