Provider Demographics
NPI:1083101075
Name:HEPHZIBAH VISITING CLINICIANS
Entity Type:Organization
Organization Name:HEPHZIBAH VISITING CLINICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SIMINIBE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-585-8129
Mailing Address - Street 1:7268 PORTILLO
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-0073
Mailing Address - Country:US
Mailing Address - Phone:469-585-8129
Mailing Address - Fax:866-803-8759
Practice Address - Street 1:111 EXECUTIVE WAY STE 102
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2388
Practice Address - Country:US
Practice Address - Phone:469-941-4029
Practice Address - Fax:866-803-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty