Provider Demographics
NPI:1366678526
Name:DALLAS METRO PROFESSIONAL HEALTH CARE AGENCY, INC.
Entity Type:Organization
Organization Name:DALLAS METRO PROFESSIONAL HEALTH CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON, ALT ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGBUJOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:214-905-9681
Mailing Address - Street 1:8204 ELMBROOK DR STE 209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4094
Mailing Address - Country:US
Mailing Address - Phone:214-905-9681
Mailing Address - Fax:214-905-9164
Practice Address - Street 1:8204 ELMBROOK DR STE 209
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4094
Practice Address - Country:US
Practice Address - Phone:214-905-9681
Practice Address - Fax:214-905-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677903OtherMEDICARE PROVIDER #