Provider Demographics
NPI:1790025237
Name:COMPASSIONATE PROVIDERS OF TEXAS
Entity Type:Organization
Organization Name:COMPASSIONATE PROVIDERS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:STACKHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:979-968-1500
Mailing Address - Street 1:PO BOX 1216
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-8216
Mailing Address - Country:US
Mailing Address - Phone:979-968-1500
Mailing Address - Fax:
Practice Address - Street 1:1495 W STATE HIGHWAY 71
Practice Address - Street 2:SUITE G, OFFICE 1
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-5137
Practice Address - Country:US
Practice Address - Phone:979-968-1500
Practice Address - Fax:979-968-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care