Provider Demographics
NPI:1104229137
Name:ANCHOR HCS
Entity type:Organization
Organization Name:ANCHOR HCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAINSTAY/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARALOTTA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-215-8165
Mailing Address - Street 1:PO BOX 80196
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13232 FENCEROW RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:682-215-8165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization