Provider Demographics
NPI:1811019367
Name:CENTRAL TEXAS HOMECARE, LLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS HOMECARE, LLC
Other - Org Name:INTERIM HEALTHCARE OF WACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:806-771-0995
Mailing Address - Street 1:3223 SOUTH LOOP 289
Mailing Address - Street 2:STE 210
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1352
Mailing Address - Country:US
Mailing Address - Phone:806-771-0995
Mailing Address - Fax:806-771-3813
Practice Address - Street 1:6801 SANGER AVE STE 268
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-7807
Practice Address - Country:US
Practice Address - Phone:254-751-9393
Practice Address - Fax:254-751-7441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011181225100000X, 225X00000X, 251E00000X, 251J00000X, 251E00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204271501Medicaid
45D0872999OtherCLIA
TX011181OtherSTATE OPERATOR LICENSE