Provider Demographics
NPI:1962768168
Name:TS CARLSON HOME HEALTH, LP
Entity type:Organization
Organization Name:TS CARLSON HOME HEALTH, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:915-779-7827
Mailing Address - Street 1:6800 GATEWAY BLVD E
Mailing Address - Street 2:BLDG 4A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-1040
Mailing Address - Country:US
Mailing Address - Phone:915-779-7827
Mailing Address - Fax:915-779-7829
Practice Address - Street 1:6800 GATEWAY BLVD E
Practice Address - Street 2:BLDG 4A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1040
Practice Address - Country:US
Practice Address - Phone:915-779-7827
Practice Address - Fax:915-779-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312190701Medicaid