Provider Demographics
NPI:1376825190
Name:CARESOURCE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:CARESOURCE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKUDAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-408-3535
Mailing Address - Street 1:525 W WESTCHESTER PKWY
Mailing Address - Street 2:#525
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2824
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 W WESTCHESTER PKWY
Practice Address - Street 2:#525
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2824
Practice Address - Country:US
Practice Address - Phone:972-408-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health