Provider Demographics
NPI:1427026582
Name:ALLEGIANCE HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ALLEGIANCE HOME HEALTH SERVICES, LLC
Other - Org Name:AMCARE PRO HOME HEALTH OF EAST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:INSIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOOTWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-593-1737
Mailing Address - Street 1:401 E FRONT ST STE 229
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8250
Mailing Address - Country:US
Mailing Address - Phone:903-593-1737
Mailing Address - Fax:903-593-1752
Practice Address - Street 1:401 E FRONT ST STE 229
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8250
Practice Address - Country:US
Practice Address - Phone:903-593-1737
Practice Address - Fax:903-593-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008374251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HH405HOtherBLUE CROSS BLUE SHIELD
TX1992513Medicaid
679290Medicare ID - Type Unspecified