Provider Demographics
NPI:1497950166
Name:MARY ANNE IGBOAGI
Entity Type:Organization
Organization Name:MARY ANNE IGBOAGI
Other - Org Name:ST JUDES HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:IGBOAGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-790-5935
Mailing Address - Street 1:3304 CHANDLER CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-2278
Mailing Address - Country:US
Mailing Address - Phone:972-790-5935
Mailing Address - Fax:214-441-3750
Practice Address - Street 1:3304 CHANDLER CT
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-2278
Practice Address - Country:US
Practice Address - Phone:972-790-5935
Practice Address - Fax:214-441-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011025251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health