Provider Demographics
NPI:1497000475
Name:ECCENTIAL HEAITH SERVICES
Entity Type:Organization
Organization Name:ECCENTIAL HEAITH SERVICES
Other - Org Name:MICHAEL CARE CONTINUUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINBORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-222-1020
Mailing Address - Street 1:701 DALWORTH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5544
Mailing Address - Country:US
Mailing Address - Phone:682-222-1020
Mailing Address - Fax:972-264-2400
Practice Address - Street 1:701 DALWORTH ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5544
Practice Address - Country:US
Practice Address - Phone:682-222-1020
Practice Address - Fax:972-264-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014281Medicaid