Provider Demographics
NPI:1467789594
Name:ROG HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ROG HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT.
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:IKPONMWOSA
Authorized Official - Last Name:OBASOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-557-8855
Mailing Address - Street 1:6340 ASHFORD TRL
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-0001
Mailing Address - Country:US
Mailing Address - Phone:469-703-5101
Mailing Address - Fax:972-692-7086
Practice Address - Street 1:6340 ASHFORD TRL
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-0001
Practice Address - Country:US
Practice Address - Phone:469-703-5101
Practice Address - Fax:972-692-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027005Medicaid