Provider Demographics
NPI:1558460402
Name:MYRTLE'S MO LOVE HOME HEALTH
Entity Type:Organization
Organization Name:MYRTLE'S MO LOVE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-286-8150
Mailing Address - Street 1:2038 TEAGARDEN CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-8683
Mailing Address - Country:US
Mailing Address - Phone:972-286-8150
Mailing Address - Fax:972-286-4153
Practice Address - Street 1:2038 TEAGARDEN CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-8683
Practice Address - Country:US
Practice Address - Phone:972-286-8150
Practice Address - Fax:972-286-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010542251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010542Medicare ID - Type UnspecifiedHOME HEALTH AGENCY