Provider Demographics
NPI:1104840867
Name:PEDIACARE OF TEXAS INC
Entity Type:Organization
Organization Name:PEDIACARE OF TEXAS INC
Other - Org Name:PEDIACARE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KUNDAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-503-5437
Mailing Address - Street 1:12810 HILLCREST RD 209 B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-503-5437
Mailing Address - Fax:972-458-7337
Practice Address - Street 1:12810 HILLCREST RD. 209 B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-503-5437
Practice Address - Fax:972-458-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010516251E00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179921501Medicaid