Provider Demographics
NPI:1679933865
Name:TEXAS CARE ONE HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:TEXAS CARE ONE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZIVEYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-377-9945
Mailing Address - Street 1:913 E BERRY ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-4452
Mailing Address - Country:US
Mailing Address - Phone:214-377-9945
Mailing Address - Fax:682-223-9349
Practice Address - Street 1:913 E BERRY ST
Practice Address - Street 2:SUITE 109
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-4452
Practice Address - Country:US
Practice Address - Phone:214-337-9945
Practice Address - Fax:682-223-9349
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS CARE ONE HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-01
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017169251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359724701Medicaid