Provider Demographics
NPI:1235714254
Name:CAREGIVERS OF FAITH HOME CARE OF DALLAS
Entity Type:Organization
Organization Name:CAREGIVERS OF FAITH HOME CARE OF DALLAS
Other - Org Name:CAREGIVERS OF FAITH HOME CARE OF DALLAS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-937-7675
Mailing Address - Street 1:124 W PIONEER PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-6146
Mailing Address - Country:US
Mailing Address - Phone:972-638-7935
Mailing Address - Fax:972-666-0303
Practice Address - Street 1:124 W PIONEER PKWY STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-6146
Practice Address - Country:US
Practice Address - Phone:972-638-7935
Practice Address - Fax:972-666-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXIMedicaid
TX423159901Medicaid