Provider Demographics
NPI:1558562827
Name:LAMONIQUE HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:LAMONIQUE HOME HEALTH SERVICES, INC
Other - Org Name:LA MONIQUE HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:ADENAIKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-266-5214
Mailing Address - Street 1:1313 TRIPOLI TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-3272
Mailing Address - Country:US
Mailing Address - Phone:972-266-5214
Mailing Address - Fax:972-262-1723
Practice Address - Street 1:1313 TRIPOLI TRL
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-3272
Practice Address - Country:US
Practice Address - Phone:972-266-5214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010277251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679791Medicare PIN