Provider Demographics
NPI:1922050848
Name:COMPLETECARE COMPREHENSIVE HEALTHCARE SOLUTIONS, LP
Entity Type:Organization
Organization Name:COMPLETECARE COMPREHENSIVE HEALTHCARE SOLUTIONS, LP
Other - Org Name:COMPLETECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MCKINNEY
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:903-757-4100
Mailing Address - Street 1:100D ROTHROCK
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75602-1535
Mailing Address - Country:US
Mailing Address - Phone:903-757-4100
Mailing Address - Fax:903-757-4125
Practice Address - Street 1:100D ROTHROCK
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75602-1535
Practice Address - Country:US
Practice Address - Phone:903-757-4100
Practice Address - Fax:903-757-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0082811332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177986002Medicaid
TX177986001Medicaid
TX177986002Medicaid