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Organization Active NPI

KDC Healthcare Partners

Doing business as Heritage Home Health of East Texas

  • Home Health Agency
  • Sulphur Springs, TX
National Provider Identifier
1275836918
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
KDC HEALTHCARE PARTNERS
Doing business as
Heritage Home Health of East Texas
Practice address
1330 Church St
Sulphur Springs, TX 75482-2161
Phone
(888) 466-3016
Fax
(888) 702-7991
NPI assigned
Dec 20, 2010
Last updated
Jul 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Christopher Stayton Clemens, RN
Title
Coo
Phone
(903) 792-0716

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

1330 Church St
Sulphur Springs, TX 75482-2161

Mailing address

4605 Texas Blvd
Texarkana, TX 75503-3028
Phone (903) 792-0716

Other identifiers 2

IdentifierTypeStateIssuer
677893OtherTXMEDICARE/PALMETTO PTAN
020457OtherTXTEXAS HEALTH AND HUMAN SERVICES COMMISION

Other names 1

  • Heritage Home Health of East Texas Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110329000763 TX Part A Provider - Home Health Agency 6901089994 Practice locations: Sulphur Springs, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275836918. Details of each certification follow.

Home health agency certification: CCN 677893

Legal name
KDC HEALTHCARE PARTNERS
Doing business as
HERITAGE HOME HEALTH OF EAST TEXAS
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 4, 2006
Last certification
Feb 10, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
1428 S Broadway St
Sulphur Springs, TX 75482-4831

Care Compare: Home health agency

Medicare Care Compare
Listed as
Heritage Home Health of East TexasCCN 677893 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Apr 4, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

2300 Joe Ramsey Blvd E
Greenville, TX 75401

1330 Church St
Sulphur Springs, TX 75482
Phone (903) 307-2300

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Blake R Rich Individual 5% Or Greater Direct Ownership InterestOwner/Ceo Oct 6, 2020 100%
Christopher Clemens Individual W-2 Managing EmployeeChief Compliance Officer Oct 6, 2020
Morgan Wilhite Individual W-2 Managing EmployeeChief Financial Officer Oct 6, 2020

Practitioners & affiliated clinicians

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1275836918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 TEXAS BLVD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033028",
            "telephone_number": "903-792-0716",
            "fax_number": "903-792-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CHURCH ST",
            "city": "SULPHUR SPRINGS",
            "state": "TX",
            "postal_code": "754822161",
            "telephone_number": "888-466-3016",
            "fax_number": "888-702-7991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KDC HEALTHCARE PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-20",
        "last_updated": "2022-07-20",
        "certification_date": "2022-06-13",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "STAYTON",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "903-792-0716",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE/PALMETTO PTAN",
            "identifier": "677893",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS HEALTH AND HUMAN SERVICES COMMISION",
            "identifier": "020457",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Home Health of East Texas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sulphur Springs, TX

Sources for this page

Verify at the official NPI Registry.