Provider Demographics
NPI:1164806394
Name:WILLOW PARK HOME HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:WILLOW PARK HOME HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMIDELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-441-2080
Mailing Address - Street 1:4971 E I-20 SERVICE RD. N
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3220
Mailing Address - Country:US
Mailing Address - Phone:817-441-2080
Mailing Address - Fax:817-441-2081
Practice Address - Street 1:4971 E I-20 SERVICE RD. N
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3220
Practice Address - Country:US
Practice Address - Phone:817-441-2080
Practice Address - Fax:817-441-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2016-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health