Provider Demographics
NPI:1346273950
Name:ABLECARE HOME HEALTH LLC
Entity type:Organization
Organization Name:ABLECARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MBA
Authorized Official - Phone:903-236-0020
Mailing Address - Street 1:2107 COURTHOUSE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2350
Mailing Address - Country:US
Mailing Address - Phone:903-236-0020
Mailing Address - Fax:903-236-0021
Practice Address - Street 1:2107 COURTHOUSE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2350
Practice Address - Country:US
Practice Address - Phone:903-236-0020
Practice Address - Fax:903-236-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008823251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherFEDERAL TAX ID PVT INSURA
TX679261Medicare ID - Type UnspecifiedPROVIDER NUMBER