Provider Demographics
NPI:1609414036
Name:PHC HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:PHC HOME HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAZZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-442-8283
Mailing Address - Street 1:9722 SKILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5150
Mailing Address - Country:US
Mailing Address - Phone:936-442-8283
Mailing Address - Fax:
Practice Address - Street 1:9722 SKILLMAN ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5150
Practice Address - Country:US
Practice Address - Phone:936-442-8283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health