Provider Demographics
NPI:1639184047
Name:DISCOVERY AT HOME IN TEXAS, LLC
Entity type:Organization
Organization Name:DISCOVERY AT HOME IN TEXAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY ASSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-707-1797
Mailing Address - Street 1:2901 W BUSCH BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4566
Mailing Address - Country:US
Mailing Address - Phone:813-634-3343
Mailing Address - Fax:813-634-3323
Practice Address - Street 1:6401 OHIO DRIVE SUITE 1107
Practice Address - Street 2:SUITE 1107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-6702
Practice Address - Country:US
Practice Address - Phone:469-808-9145
Practice Address - Fax:469-808-9146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679350Medicare Oscar/Certification