Provider Demographics
NPI:1629113378
Name:UT HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:UT HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUDEBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MBA
Authorized Official - Phone:817-633-1995
Mailing Address - Street 1:1111 111TH STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-7705
Mailing Address - Country:US
Mailing Address - Phone:817-633-1995
Mailing Address - Fax:817-633-1250
Practice Address - Street 1:1111 111TH STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7705
Practice Address - Country:US
Practice Address - Phone:817-633-1995
Practice Address - Fax:817-633-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010106251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010106OtherDAD'S LICENSE
TX679597Medicare PIN