Provider Demographics
NPI:1295408854
Name:C & D PEDIATRIC HOME CARE LLC
Entity Type:Organization
Organization Name:C & D PEDIATRIC HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPOLITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:693-636-5344
Mailing Address - Street 1:1708 TIGRIS TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1572
Mailing Address - Country:US
Mailing Address - Phone:469-363-6534
Mailing Address - Fax:972-584-1708
Practice Address - Street 1:1708 TIGRIS TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1572
Practice Address - Country:US
Practice Address - Phone:469-363-6534
Practice Address - Fax:972-584-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4693636534Medicaid