Provider Demographics
NPI:1083711261
Name:PROLINK HOME HEALTH CORPORATION
Entity Type:Organization
Organization Name:PROLINK HOME HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTARTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-267-1985
Mailing Address - Street 1:4100 MEDICAL PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1541
Mailing Address - Country:US
Mailing Address - Phone:214-267-1985
Mailing Address - Fax:214-267-1983
Practice Address - Street 1:4100 MEDICAL PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1541
Practice Address - Country:US
Practice Address - Phone:214-267-1985
Practice Address - Fax:214-267-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009767251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLICENSE # 009767OtherTEXAS DEPARTMENT OF AGING AND DISABILITY SERVICES
TX206172301Medicaid
677805Medicare ID - Type Unspecified