Provider Demographics
NPI:1952313819
Name:CQ HOME HEALTH ACQUISITION HOLDINGS LP
Entity Type:Organization
Organization Name:CQ HOME HEALTH ACQUISITION HOLDINGS LP
Other - Org Name:JORDAN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-537-8629
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:412 HWY 37 SOUTH
Mailing Address - City:MOUNT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-1387
Mailing Address - Country:US
Mailing Address - Phone:903-537-8629
Mailing Address - Fax:903-537-8440
Practice Address - Street 1:1101 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5008
Practice Address - Country:US
Practice Address - Phone:940-761-6191
Practice Address - Fax:940-761-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009382251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673113Medicare Oscar/Certification
TX673113Medicare Oscar/Certification