Provider Demographics
NPI:1578998472
Name:PROXIMUS HOME HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PROXIMUS HOME HEALTH SERVICES INC
Other - Org Name:PROXIMUS HOME HEALTH SERVICES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ETIENNE
Authorized Official - Middle Name:CLEMENT
Authorized Official - Last Name:POUFONG
Authorized Official - Suffix:
Authorized Official - Credentials:RN-BSN
Authorized Official - Phone:817-633-9058
Mailing Address - Street 1:2401 AVENUE J
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-6230
Mailing Address - Country:US
Mailing Address - Phone:817-633-9058
Mailing Address - Fax:817-471-3269
Practice Address - Street 1:2401 AVENUE J
Practice Address - Street 2:SUITE 215
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6230
Practice Address - Country:US
Practice Address - Phone:817-633-9058
Practice Address - Fax:817-471-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016074251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care