Provider Demographics
NPI:1588840599
Name:PASSION 05 HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PASSION 05 HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALERO
Authorized Official - Middle Name:TINA
Authorized Official - Last Name:OKUNDIA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-253-2654
Mailing Address - Street 1:1140 EMPIRE CENTRAL DR STE 630
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4393
Mailing Address - Country:US
Mailing Address - Phone:214-253-2654
Mailing Address - Fax:214-253-2655
Practice Address - Street 1:1140 EMPIRE CENTRAL DR STE 630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4393
Practice Address - Country:US
Practice Address - Phone:214-253-2654
Practice Address - Fax:214-253-2655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679708Medicare PIN