Provider Demographics
NPI:1083156533
Name:EMPLOYER DIRECT HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EMPLOYER DIRECT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTENKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-590-1706
Mailing Address - Street 1:2100 ROSS AVE STE 550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-2739
Mailing Address - Country:US
Mailing Address - Phone:855-290-2999
Mailing Address - Fax:
Practice Address - Street 1:2100 ROSS AVE STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2739
Practice Address - Country:US
Practice Address - Phone:855-290-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty