Provider Demographics
NPI:1699190884
Name:UNDERWOOD HOME CARE INC
Entity Type:Organization
Organization Name:UNDERWOOD HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-221-4522
Mailing Address - Street 1:14902 PRESTON RD # 404-327
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-9191
Mailing Address - Country:US
Mailing Address - Phone:254-432-4252
Mailing Address - Fax:254-594-2250
Practice Address - Street 1:64 W ELM ST FL 2
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645
Practice Address - Country:US
Practice Address - Phone:254-432-4252
Practice Address - Fax:254-594-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679573Medicare Oscar/Certification