Provider Demographics
NPI:1417320789
Name:DAY HOME VISITS MHT LLC
Entity Type:Organization
Organization Name:DAY HOME VISITS MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-566-6764
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:214-616-4932
Mailing Address - Fax:877-489-3949
Practice Address - Street 1:1515 HERITAGE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3256
Practice Address - Country:US
Practice Address - Phone:972-616-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-08
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1411207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00040A0AM6Medicaid