Provider Demographics
NPI:1720135098
Name:SOUTHEAST TEXAS HOMECARE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS HOMECARE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-842-0077
Mailing Address - Street 1:1846 INTERSTATE 10 S
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4439
Mailing Address - Country:US
Mailing Address - Phone:409-842-0077
Mailing Address - Fax:406-842-2411
Practice Address - Street 1:1846 INTERSTATE 10 S
Practice Address - Street 2:SUITE 201
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4439
Practice Address - Country:US
Practice Address - Phone:409-842-0077
Practice Address - Fax:409-842-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005104251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH9297OtherBCBS PROVIDER NUMBER
TX005104OtherSTATE LICENSE
TX=========OtherEIN NUMBER
TXHH9297OtherBCBS PROVIDER NUMBER