Provider Demographics
NPI:1104835792
Name:JOSEPH MARY CARE PROVIDERS INC
Entity Type:Organization
Organization Name:JOSEPH MARY CARE PROVIDERS INC
Other - Org Name:JOSEPH/MARY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:IDOWU
Authorized Official - Last Name:OLAYINKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-727-0409
Mailing Address - Street 1:12160 ABRAMS RD
Mailing Address - Street 2:SUITE 417
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4547
Mailing Address - Country:US
Mailing Address - Phone:214-349-8888
Mailing Address - Fax:214-349-8883
Practice Address - Street 1:12160 ABRAMS RD
Practice Address - Street 2:SUITE 417
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4547
Practice Address - Country:US
Practice Address - Phone:214-349-8888
Practice Address - Fax:214-349-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011971251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011971OtherSTATE LICENSE
TX011971OtherSTATE LICENSE