Provider Demographics
NPI:1598187130
Name:PC HOME HEALTH
Entity Type:Organization
Organization Name:PC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:MOURY'E
Authorized Official - Last Name:BEACHUM
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:214-991-5619
Mailing Address - Street 1:1155 WARRIOR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-5073
Mailing Address - Country:US
Mailing Address - Phone:214-991-5619
Mailing Address - Fax:214-484-2376
Practice Address - Street 1:1155 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-5073
Practice Address - Country:US
Practice Address - Phone:214-991-5619
Practice Address - Fax:214-484-2376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health