Provider Demographics
NPI:1891798963
Name:CARDIOVASCULAR HOME CARE, INC.
Entity Type:Organization
Organization Name:CARDIOVASCULAR HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-847-8888
Mailing Address - Street 1:2501 PARKVIEW DR
Mailing Address - Street 2:STE 426
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5815
Mailing Address - Country:US
Mailing Address - Phone:817-847-8888
Mailing Address - Fax:817-847-1884
Practice Address - Street 1:2501 PARKVIEW DR
Practice Address - Street 2:STE 426
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-5815
Practice Address - Country:US
Practice Address - Phone:817-847-8888
Practice Address - Fax:817-847-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002934251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX458125Medicare ID - Type UnspecifiedMEDICARE NUMBER