Provider Demographics
NPI:1528884780
Name:CHOCTAW HOLDING GROUP LLC
Entity type:Organization
Organization Name:CHOCTAW HOLDING GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-314-0084
Mailing Address - Street 1:9052 GALEWOOD DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-6437
Mailing Address - Country:US
Mailing Address - Phone:870-314-0084
Mailing Address - Fax:
Practice Address - Street 1:9052 GALEWOOD DR UNIT 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6437
Practice Address - Country:US
Practice Address - Phone:870-314-0084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOCTAW HOLDING GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health