Provider Demographics
NPI:1811940844
Name:EAST TEXAS CARETEAM INC.
Entity type:Organization
Organization Name:EAST TEXAS CARETEAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-663-2331
Mailing Address - Street 1:4362 N US HIGHWAY 259
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-7674
Mailing Address - Country:US
Mailing Address - Phone:903-663-2331
Mailing Address - Fax:903-663-4831
Practice Address - Street 1:4362 N US HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-7674
Practice Address - Country:US
Practice Address - Phone:903-663-2331
Practice Address - Fax:903-663-4831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005903251G00000X, 251E00000X
TX012954251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002198Medicaid
TX025111801Medicaid
TX025111801Medicaid