Provider Demographics
NPI:1003091968
Name:EMMANUEL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:EMMANUEL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAIFU
Authorized Official - Middle Name:FOLUWASO
Authorized Official - Last Name:MUSTAPHA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:817-784-9454
Mailing Address - Street 1:1111 W ARKANSAS LN STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6376
Mailing Address - Country:US
Mailing Address - Phone:817-784-9454
Mailing Address - Fax:817-467-7055
Practice Address - Street 1:1111 W ARKANSAS LN STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6376
Practice Address - Country:US
Practice Address - Phone:817-784-9454
Practice Address - Fax:817-467-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011701251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679209Medicare Oscar/Certification