Provider Demographics
NPI:1659731297
Name:HOMEWELL NORTH TEXAS, LLC
Entity Type:Organization
Organization Name:HOMEWELL NORTH TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-203-8313
Mailing Address - Street 1:812 SHEPPARD RD
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2706
Mailing Address - Country:US
Mailing Address - Phone:817-203-8313
Mailing Address - Fax:888-833-3628
Practice Address - Street 1:812 SHEPPARD RD
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-2663
Practice Address - Country:US
Practice Address - Phone:817-203-8313
Practice Address - Fax:888-833-3628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOMEWELL CORPORATE HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-24
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care