Provider Demographics
NPI:1154460301
Name:1ST MELLINIUM HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:1ST MELLINIUM HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMUSOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-946-1122
Mailing Address - Street 1:2730 N STEMMONS FWY STE 706
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2205
Mailing Address - Country:US
Mailing Address - Phone:214-946-1122
Mailing Address - Fax:214-946-7337
Practice Address - Street 1:2730 N STEMMONS FWY STE 706
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2205
Practice Address - Country:US
Practice Address - Phone:214-946-1122
Practice Address - Fax:214-946-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008405251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459493Medicare Oscar/Certification