Provider Demographics
NPI:1649209578
Name:OUTREACH MEDICAL HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:OUTREACH MEDICAL HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-572-7703
Mailing Address - Street 1:7010 AMERICAN WAY
Mailing Address - Street 2:STE. I
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-2499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7010 AMERICAN WAY
Practice Address - Street 2:STE. I
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-2499
Practice Address - Country:US
Practice Address - Phone:972-572-7703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003226251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458288Medicare ID - Type UnspecifiedPROVIDER NUMBER