Provider Demographics
NPI:1215995006
Name:EAST TEXAS HOME HEALTH, INC
Entity type:Organization
Organization Name:EAST TEXAS HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOXWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:936-969-2103
Mailing Address - Street 1:14046 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:TX
Mailing Address - Zip Code:75936-2518
Mailing Address - Country:US
Mailing Address - Phone:936-969-2103
Mailing Address - Fax:936-969-2101
Practice Address - Street 1:14046 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:TX
Practice Address - Zip Code:75936-2518
Practice Address - Country:US
Practice Address - Phone:936-969-2103
Practice Address - Fax:936-969-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004081251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0249872-01Medicaid
TX0249872-01Medicaid