Provider Demographics
NPI:1982003778
Name:GREAT PROVIDER CAREGIVERS
Entity Type:Organization
Organization Name:GREAT PROVIDER CAREGIVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MOTR
Authorized Official - Phone:817-635-6088
Mailing Address - Street 1:2233 AVENUE J STE 107
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-5884
Mailing Address - Country:US
Mailing Address - Phone:817-635-6088
Mailing Address - Fax:817-633-3976
Practice Address - Street 1:2233 AVENUE J STE 107
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-5884
Practice Address - Country:US
Practice Address - Phone:817-635-6088
Practice Address - Fax:817-633-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherIRS