Provider Demographics
NPI:1548518004
Name:DAVIS HOME CARE, LLC
Entity type:Organization
Organization Name:DAVIS HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-908-7528
Mailing Address - Street 1:2509 RICHMOND RD
Mailing Address - Street 2:#250
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-2324
Mailing Address - Country:US
Mailing Address - Phone:903-244-6306
Mailing Address - Fax:
Practice Address - Street 1:2605 TEXAS BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4175
Practice Address - Country:US
Practice Address - Phone:903-244-6306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care