Provider Demographics
NPI:1932285996
Name:GERALD JACKSON GALLOUPE
Entity Type:Organization
Organization Name:GERALD JACKSON GALLOUPE
Other - Org Name:HOMEBOUND HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:GALLOUPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-838-4941
Mailing Address - Street 1:1705 NORTH BISHOP
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-2800
Mailing Address - Country:US
Mailing Address - Phone:903-838-4941
Mailing Address - Fax:903-838-5128
Practice Address - Street 1:1705 NORTH BISHOP
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-2800
Practice Address - Country:US
Practice Address - Phone:903-838-4941
Practice Address - Fax:903-838-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX002258251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH9968OtherBC/BS OF TEXAS
TX002258OtherSTATE LICENSE
TX002258OtherSTATE LICENSE