Provider Demographics
NPI:1881979904
Name:CARISSA HEALTH CARE SERVICES INC.
Entity type:Organization
Organization Name:CARISSA HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGORL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-531-3165
Mailing Address - Street 1:10701 CORPORATE DRIVE, SUITE 340-113
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477
Mailing Address - Country:US
Mailing Address - Phone:979-531-3165
Mailing Address - Fax:979-531-3166
Practice Address - Street 1:10701 CORPORATE DR, SUITE 340-113
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477
Practice Address - Country:US
Practice Address - Phone:979-531-3165
Practice Address - Fax:979-531-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014898251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3496291Medicaid