Provider Demographics
NPI:1891790135
Name:STEPHEN'S HEALTH CARE, INC.
Entity Type:Organization
Organization Name:STEPHEN'S HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAVINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:254-965-6629
Mailing Address - Street 1:711 N GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-3148
Mailing Address - Country:US
Mailing Address - Phone:254-965-6629
Mailing Address - Fax:254-965-7040
Practice Address - Street 1:711 N GRAHAM ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-3148
Practice Address - Country:US
Practice Address - Phone:254-965-6629
Practice Address - Fax:254-965-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004548251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677624Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
677624Medicare Oscar/Certification