Onesource Home Care, Inc.
Organization Active NPI Home Health Agency · Longview, TX
NPI 1104147339 · NPPES record last updated Aug 6, 2020
Key facts
- NPI
- 1104147339
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- ONESOURCE HOME CARE, INC.
- Practice address
- 4002 Technology Ctr
Longview, TX 75605-2697 - Phone
- (903) 247-0484
- Fax
- (903) 247-0485
- NPI assigned
- Jun 22, 2010
- Organization subpart
- No
Authorized official
- Name
- John D Ford
- Title
- President
- Phone
- (903) 247-0484
Owners & managing parties with NPI records 8
Member of 2
Facilities with the same owner 1
Affiliated clinicians 63
-
Martha Barr, FNP-C
-
William Bowling, P.A
-
Nancy Buettner, PA-C
-
Darrell A Bunch, D.O.
-
Laine Anderson Claxton, APRN
-
Michelle Engdayehu, RN FNP
-
Trent Eugene Gale, FNP
-
March Ellen Gray, FNP-C
-
Tara Gray, FNP
-
Heather Grindle, FNP
-
Jeffrey Blake Hart, M.D.
-
Kamri Hickerson, MPAS, PA-C
-
Beverly K Iltis, PA
-
Kyle Jordan Jones, FNP-C
-
Lewis Roy King, MD
-
Brandi Langdon, FNP
Medicare Care Compare: Home health agency
- Listed as
- Onesource Home Care Inc
- Overall star rating
- ★★★★☆ 4 of 5
- Ownership
- Proprietary
- Certified
- May 30, 2002
- Medicare certification status
- Active
- Services
- Nursing, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Home health agency certification: CCN 679138
- Legal name
- ONESOURCE HOME CARE INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- May 30, 2002
- Last certification
- May 20, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Proprietary
- Incorporated
- Jun 16, 2010 in TX
- Enrollment address
- 4001 Technology Ctr
Ste 304
Longview, TX 75605-2757
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Primecare LLC |
5% Or Greater Direct Ownership Interest | Jun 1, 2020 | 100% |
| Collom & Carney Clinic Association |
5% Or Greater Indirect Ownership Interest | Jun 1, 2020 | 33.33% |
| John Ford |
5% Or Greater Indirect Ownership Interest | Jun 1, 2020 | 33.33% |
| Corporate Officer |
Jun 1, 2020 | ||
| Corporate Director |
Jun 1, 2020 | ||
| W-2 Managing Employee |
Jun 1, 2020 | ||
| Operational/Managerial Control |
Jun 1, 2020 | ||
| Associated Clinicians of East Texas |
5% Or Greater Indirect Ownership Interest | Jun 1, 2020 | 33.33% |
| Triad Physician Resources |
5% Or Greater Indirect Ownership Interest | Jun 1, 2020 | 33.33% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120822000330 | TX | Part a Provider - Home Health Agency | 1355598616 | Practice locations: Longview, TX |
National Provider Directory
Locations
4001 Technology Ctr
Ste 304
Longview, TX 75605
Phone (903) 248-2530
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
4002 Technology Ctr
Longview, TX 75605-2697
Mailing address
4002 Technology Ctr
Longview, TX 75605-2697
Phone (903) 247-0484
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245214873 | Other | NPI |
Other names
- Grace Independent Home Care Inc
Other providers in Longview, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.