Provider Demographics
NPI:1376653642
Name:FARMINGTON PLACE HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:FARMINGTON PLACE HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:OLUGBOLAHAN
Authorized Official - Last Name:OGUNDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-544-0180
Mailing Address - Street 1:3104 NORMANDY DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4733
Mailing Address - Country:US
Mailing Address - Phone:214-544-0180
Mailing Address - Fax:214-544-0064
Practice Address - Street 1:901 N MCDONALD ST STE 504
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-2166
Practice Address - Country:US
Practice Address - Phone:214-544-0180
Practice Address - Fax:214-544-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008681251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9059OtherHOME HEALTH LICENSE #2
TX163833001Medicaid
TX9059OtherHOME HEALTH LICENSE #2
679437Medicare Oscar/Certification
TX679437Medicare PIN