Provider Demographics
NPI:1790097293
Name:THERACARE HOME HEALTH OF AUSTIN, LLC
Entity Type:Organization
Organization Name:THERACARE HOME HEALTH OF AUSTIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-908-6353
Mailing Address - Street 1:240 CANYON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-9658
Mailing Address - Country:US
Mailing Address - Phone:214-908-6353
Mailing Address - Fax:940-241-1246
Practice Address - Street 1:13809 RESEARCH BLVD
Practice Address - Street 2:SUITE 425
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1241
Practice Address - Country:US
Practice Address - Phone:512-459-6565
Practice Address - Fax:512-459-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
67-9293Medicare PIN