Provider Demographics
NPI:1417250879
Name:HEALING ARK HOME HEALTH PEDIATRIC SERVICES INC.
Entity Type:Organization
Organization Name:HEALING ARK HOME HEALTH PEDIATRIC SERVICES INC.
Other - Org Name:ARK HOME HEALTH CARE PEDIATRIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-559-9213
Mailing Address - Street 1:1240 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4306
Mailing Address - Country:US
Mailing Address - Phone:817-952-3093
Mailing Address - Fax:
Practice Address - Street 1:1240 SOUTHRIDGE CT
Practice Address - Street 2:SUITE 106
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4306
Practice Address - Country:US
Practice Address - Phone:817-952-3093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health