Provider Demographics
NPI:1871632513
Name:NORTHEAST TEXAS HOME HEALTH AGENCY LTD
Entity Type:Organization
Organization Name:NORTHEAST TEXAS HOME HEALTH AGENCY LTD
Other - Org Name:VITALCARING GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-839-3706
Mailing Address - Street 1:8150 N CENTRAL EXPY STE 1800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1883
Mailing Address - Country:US
Mailing Address - Phone:469-839-3777
Mailing Address - Fax:469-983-2083
Practice Address - Street 1:2015 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-5155
Practice Address - Country:US
Practice Address - Phone:903-657-1004
Practice Address - Fax:903-657-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002875251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH8314OtherBLUECROSS BLUE SHIELD
TX023843801Medicaid