Provider Demographics
NPI:1710155023
Name:ARK ABOVE HOME HEALTH AGENCY, LLC.
Entity Type:Organization
Organization Name:ARK ABOVE HOME HEALTH AGENCY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-320-7200
Mailing Address - Street 1:5409 N JIM MILLER RD
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-1542
Mailing Address - Country:US
Mailing Address - Phone:214-320-7200
Mailing Address - Fax:214-320-7203
Practice Address - Street 1:5409 N JIM MILLER RD
Practice Address - Street 2:SUITE 203B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-1542
Practice Address - Country:US
Practice Address - Phone:214-320-7200
Practice Address - Fax:214-320-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012267251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012267OtherLICENSE