Provider Demographics
NPI:1558393025
Name:MY REDEEMER HEALTHCARE SERVICES AND CONSULT,LLC
Entity Type:Organization
Organization Name:MY REDEEMER HEALTHCARE SERVICES AND CONSULT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/D.O.N.
Authorized Official - Prefix:
Authorized Official - First Name:ADESOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSIBAMOWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-952-1478
Mailing Address - Street 1:850 S GREENVILLE AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-5090
Mailing Address - Country:US
Mailing Address - Phone:972-952-1478
Mailing Address - Fax:972-952-1479
Practice Address - Street 1:850 S GREENVILLE AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-5090
Practice Address - Country:US
Practice Address - Phone:972-952-1478
Practice Address - Fax:972-952-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459097Medicare Oscar/Certification