Provider Demographics
NPI:1942299698
Name:GEORGETOWN HEALTHCARE SYSTEM INC
Entity Type:Organization
Organization Name:GEORGETOWN HEALTHCARE SYSTEM INC
Other - Org Name:GEORGETOWN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-930-2816
Mailing Address - Street 1:2120 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7728
Mailing Address - Country:US
Mailing Address - Phone:512-930-2816
Mailing Address - Fax:512-869-2494
Practice Address - Street 1:2120 SCENIC DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7728
Practice Address - Country:US
Practice Address - Phone:512-930-2816
Practice Address - Fax:512-869-2494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091445902Medicaid
TX457709Medicare Oscar/Certification