Provider Demographics
NPI:1073837514
Name:MGA HEALTHCARE TEXAS, LLC
Entity Type:Organization
Organization Name:MGA HEALTHCARE TEXAS, LLC
Other - Org Name:MGA HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KOLOSKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-276-7706
Mailing Address - Street 1:7025 N SCOTTSDALE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3675
Mailing Address - Country:US
Mailing Address - Phone:602-508-1883
Mailing Address - Fax:602-385-4941
Practice Address - Street 1:15601 DALLAS PKWY STE 125
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3499
Practice Address - Country:US
Practice Address - Phone:214-292-9900
Practice Address - Fax:214-292-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X
TX015128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213979201Medicaid