Provider Demographics
NPI:1578631537
Name:BLEDKOB HOME HEALTH AGENCY INC.
Entity Type:Organization
Organization Name:BLEDKOB HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:D
Authorized Official - Last Name:OGIDI
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:214-547-0736
Mailing Address - Street 1:1314 WINECUP CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-0983
Mailing Address - Country:US
Mailing Address - Phone:214-547-0736
Mailing Address - Fax:214-383-0241
Practice Address - Street 1:1314 WINECUP CT
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-0983
Practice Address - Country:US
Practice Address - Phone:214-547-0736
Practice Address - Fax:214-383-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009826251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-7944Medicare ID - Type Unspecified