Provider Demographics
NPI:1578884276
Name:PROVIDERS HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:PROVIDERS HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANELECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-542-9125
Mailing Address - Street 1:2861 INGRAM CIR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-4425
Mailing Address - Country:US
Mailing Address - Phone:214-542-9125
Mailing Address - Fax:972-222-7923
Practice Address - Street 1:2861 INGRAM CIR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-4425
Practice Address - Country:US
Practice Address - Phone:214-542-9125
Practice Address - Fax:972-222-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health