Provider Demographics
NPI:1407916356
Name:IDEAL HOME HEALTH, INC
Entity Type:Organization
Organization Name:IDEAL HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-374-6800
Mailing Address - Street 1:2501 OAK LAWN AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4079
Mailing Address - Country:US
Mailing Address - Phone:214-374-6800
Mailing Address - Fax:214-374-6871
Practice Address - Street 1:2501 OAK LAWN AVE STE 275
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4079
Practice Address - Country:US
Practice Address - Phone:214-374-6800
Practice Address - Fax:214-374-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008166251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679277Medicare ID - Type UnspecifiedPROVIDER NUMBER