Provider Demographics
NPI:1518965367
Name:ADC HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:ADC HEALTH CARE SERVICES INC
Other - Org Name:ALLIED HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:IMOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:214-221-2400
Mailing Address - Street 1:9304 FOREST LN
Mailing Address - Street 2:SUITE NO. S-248
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2103
Mailing Address - Country:US
Mailing Address - Phone:214-221-2400
Mailing Address - Fax:214-221-2402
Practice Address - Street 1:9304 FOREST LN
Practice Address - Street 2:SUITE NO. S-248
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2103
Practice Address - Country:US
Practice Address - Phone:214-221-2400
Practice Address - Fax:214-221-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008770251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180825501Medicaid
00103118OtherTX DEPT OF AGING & DISABILITY SRVCS
TX453117Medicare ID - Type Unspecified
008770Medicare Oscar/Certification