Provider Demographics
NPI:1093315913
Name:PINK SCRUBS HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:PINK SCRUBS HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARLETHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-968-8602
Mailing Address - Street 1:10815 BAUCUM RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-7614
Mailing Address - Country:US
Mailing Address - Phone:734-968-8602
Mailing Address - Fax:
Practice Address - Street 1:10815 BAUCUM RD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-7614
Practice Address - Country:US
Practice Address - Phone:734-968-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care