Provider Demographics
NPI:1497826846
Name:PROMISE HOMEHEALTH INC.
Entity Type:Organization
Organization Name:PROMISE HOMEHEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:ATUEGBUNAM
Authorized Official - Last Name:ONYEDINMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-603-6939
Mailing Address - Street 1:3216 SILVER CREEK DR.
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-2967
Mailing Address - Country:US
Mailing Address - Phone:972-603-6939
Mailing Address - Fax:469-930-8897
Practice Address - Street 1:10114 EKUKPE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-2809
Practice Address - Country:US
Practice Address - Phone:972-603-6939
Practice Address - Fax:469-930-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747041Medicare Oscar/Certification