Provider Demographics
NPI:1710219720
Name:TOTALCARE COMPREHENSIVE HOME HEALTH SUPPLY
Entity Type:Organization
Organization Name:TOTALCARE COMPREHENSIVE HOME HEALTH SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-592-3300
Mailing Address - Street 1:401 E FRONT ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8213
Mailing Address - Country:US
Mailing Address - Phone:903-592-3300
Mailing Address - Fax:903-592-3301
Practice Address - Street 1:1100 STONE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-5482
Practice Address - Country:US
Practice Address - Phone:903-986-3792
Practice Address - Fax:903-986-3793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies