Provider Demographics
NPI:1710522982
Name:AT MY VILLAGE HOME HEALTH CARE
Entity Type:Organization
Organization Name:AT MY VILLAGE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:DUMISANI
Authorized Official - Last Name:MAHLORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-819-9957
Mailing Address - Street 1:2424 POINCIANA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212
Mailing Address - Country:US
Mailing Address - Phone:203-819-9957
Mailing Address - Fax:
Practice Address - Street 1:2424 POINCIANA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212
Practice Address - Country:US
Practice Address - Phone:203-819-9957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AT MY VILLAGE HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty