Provider Demographics
NPI:1629254842
Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, LC
Entity Type:Organization
Organization Name:OUTREACH HEALTH COMMUNITY CARE SERVICES, LC
Other - Org Name:OUTREACH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE LEGAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-703-1310
Mailing Address - Street 1:251 RENNER PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1316
Mailing Address - Country:US
Mailing Address - Phone:512-692-7834
Mailing Address - Fax:972-792-6739
Practice Address - Street 1:222 PENNBRIGHT DR STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-5907
Practice Address - Country:US
Practice Address - Phone:281-872-4495
Practice Address - Fax:281-872-4560
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUTREACH HEALTH CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-17
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 333300000X, 385H00000X, 251B00000X
TX007338251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No333300000XSuppliersEmergency Response System Companies
No385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629254842OtherREGION 06 - PCS
TX185485301Medicaid