Provider Demographics
NPI:1134317936
Name:CENTENNIAL HOME HEALTH INC
Entity Type:Organization
Organization Name:CENTENNIAL HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INITA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-339-2776
Mailing Address - Street 1:8702 S LANCASTER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6319
Mailing Address - Country:US
Mailing Address - Phone:217-339-2776
Mailing Address - Fax:214-339-2784
Practice Address - Street 1:8702 S LANCASTER RD STE 160
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75241-6319
Practice Address - Country:US
Practice Address - Phone:217-339-2776
Practice Address - Fax:214-339-2784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021999OtherLICENCE