Provider Demographics
NPI:1265975163
Name:CARE TRACK CONSULTING LLC
Entity type:Organization
Organization Name:CARE TRACK CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, GNP-BC
Authorized Official - Phone:214-213-4726
Mailing Address - Street 1:5440 HARVEST HILL RD STE 182
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1605
Mailing Address - Country:US
Mailing Address - Phone:214-213-4726
Mailing Address - Fax:866-672-8204
Practice Address - Street 1:5440 HARVEST HILL RD STE 182
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1605
Practice Address - Country:US
Practice Address - Phone:214-213-4726
Practice Address - Fax:866-672-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-23
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115470251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548396849OtherINDIVIDUAL NPI
TXTXB131306OtherMEDICARE