Provider Demographics
NPI:1629180153
Name:NOVELL HOME HEALTH
Entity Type:Organization
Organization Name:NOVELL HOME HEALTH
Other - Org Name:NOVELL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANENE
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:972-602-6913
Mailing Address - Street 1:3403 BRYCE CYN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7874
Mailing Address - Country:US
Mailing Address - Phone:972-602-6913
Mailing Address - Fax:972-602-6913
Practice Address - Street 1:3403 BRYCE CYN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7874
Practice Address - Country:US
Practice Address - Phone:469-235-5120
Practice Address - Fax:972-602-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010037251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health