Provider Demographics
NPI:1003108721
Name:PEDIATRIC HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HOSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-630-4811
Mailing Address - Street 1:1341 W MOCKINGBIRD LN # 780W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6913
Mailing Address - Country:US
Mailing Address - Phone:972-630-4811
Mailing Address - Fax:
Practice Address - Street 1:1300 SUMMIT AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102
Practice Address - Country:US
Practice Address - Phone:817-710-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014301Medicaid