Provider Demographics
NPI:1083929970
Name:STELLA C EGEONU MBR
Entity Type:Organization
Organization Name:STELLA C EGEONU MBR
Other - Org Name:VALLEY TRAIL HOME HEALTHCARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:EGEONU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-566-0779
Mailing Address - Street 1:2112 LAKE BEND DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-7741
Mailing Address - Country:US
Mailing Address - Phone:214-566-0779
Mailing Address - Fax:972-871-1227
Practice Address - Street 1:2112 LAKE BEND DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-7741
Practice Address - Country:US
Practice Address - Phone:214-566-0779
Practice Address - Fax:972-871-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health