Provider Demographics
NPI:1801912050
Name:BIG COUNTRY HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:BIG COUNTRY HEALTHCARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-675-0559
Mailing Address - Street 1:749 GATEWAY ST. BUILDING F
Mailing Address - Street 2:SUITE 702
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-1196
Mailing Address - Country:US
Mailing Address - Phone:325-675-0559
Mailing Address - Fax:325-675-0591
Practice Address - Street 1:749 GATEWAY ST. BUILDING F
Practice Address - Street 2:SUITE 702
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-1196
Practice Address - Country:US
Practice Address - Phone:325-675-0559
Practice Address - Fax:325-675-0591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010529251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1846677Medicaid
TX1846677Medicaid