Provider Demographics
NPI:1679689012
Name:PLATINUM HEALTH SERVICE
Entity Type:Organization
Organization Name:PLATINUM HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANAH
Authorized Official - Middle Name:FOLUKE
Authorized Official - Last Name:OKUNADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-982-0192
Mailing Address - Street 1:2023 DEEPWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-1723
Mailing Address - Country:US
Mailing Address - Phone:972-982-0192
Mailing Address - Fax:972-784-5404
Practice Address - Street 1:2023 DEEPWOOD ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-1723
Practice Address - Country:US
Practice Address - Phone:972-839-3529
Practice Address - Fax:214-221-4908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1786238Medicaid
TX673108Medicare ID - Type UnspecifiedPROVIDER NUMBER