Provider Demographics
NPI:1699134296
Name:CATERPILLAR HOME HEALTH FOR KIDS LLC
Entity type:Organization
Organization Name:CATERPILLAR HOME HEALTH FOR KIDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLAW
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-863-2296
Mailing Address - Street 1:5902 PRESTON OAKS RD APT 2047
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8769
Mailing Address - Country:US
Mailing Address - Phone:972-863-2296
Mailing Address - Fax:
Practice Address - Street 1:5902 PRESTON OAKS RD APT 2047
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8769
Practice Address - Country:US
Practice Address - Phone:972-863-2296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017361OtherLICENSE