Provider Demographics
NPI:1578031381
Name:CLASSIC HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:CLASSIC HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-908-0135
Mailing Address - Street 1:777 S CENTRAL EXPY STE 1K
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7412
Mailing Address - Country:US
Mailing Address - Phone:972-365-8224
Mailing Address - Fax:
Practice Address - Street 1:777 S CENTRAL EXPY STE 1K
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7412
Practice Address - Country:US
Practice Address - Phone:972-365-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care