Provider Demographics
NPI:1639366883
Name:FAB 4 ALLIANCE LLC
Entity Type:Organization
Organization Name:FAB 4 ALLIANCE LLC
Other - Org Name:RELIANT HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PADUA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-240-3367
Mailing Address - Street 1:1120 N GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2436
Mailing Address - Country:US
Mailing Address - Phone:972-288-3800
Mailing Address - Fax:972-288-3802
Practice Address - Street 1:1120 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2436
Practice Address - Country:US
Practice Address - Phone:972-288-3800
Practice Address - Fax:972-288-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011244251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011244OtherTX- DADS HCSSA LICENCE