Provider Demographics
NPI:1760667943
Name:KATHY ANN PIPPINS WILLIAMS
Entity Type:Organization
Organization Name:KATHY ANN PIPPINS WILLIAMS
Other - Org Name:DIVINE CARE HOME NURSING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:ANN PIPPINS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,RN
Authorized Official - Phone:903-753-1000
Mailing Address - Street 1:911 PEGUES PL
Mailing Address - Street 2:STE A
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4027
Mailing Address - Country:US
Mailing Address - Phone:903-753-1000
Mailing Address - Fax:903-753-1225
Practice Address - Street 1:911 PEGUES PL
Practice Address - Street 2:STE A
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4027
Practice Address - Country:US
Practice Address - Phone:903-753-1000
Practice Address - Fax:903-753-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherEIN
TX=========OtherEIN