Provider Demographics
NPI:1326372582
Name:CROWNDESEA HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:CROWNDESEA HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:ADEWOLE
Authorized Official - Last Name:ADEDOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-298-7030
Mailing Address - Street 1:1322 SAN MIGUEL DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3073
Mailing Address - Country:US
Mailing Address - Phone:972-298-7030
Mailing Address - Fax:972-298-7180
Practice Address - Street 1:1322 SAN MIGUEL DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-3073
Practice Address - Country:US
Practice Address - Phone:972-298-7030
Practice Address - Fax:972-298-7180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-21
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014245251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health