Provider Demographics
NPI:1265999510
Name:ZOHTEG HOME HEALTHCARE
Entity type:Organization
Organization Name:ZOHTEG HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-350-0386
Mailing Address - Street 1:4311 TIDAL WAVE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4307
Mailing Address - Country:US
Mailing Address - Phone:254-350-0386
Mailing Address - Fax:
Practice Address - Street 1:4311 TIDAL WAVE DR
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4307
Practice Address - Country:US
Practice Address - Phone:254-350-0386
Practice Address - Fax:254-598-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care