Provider Demographics
NPI:1720564743
Name:PRODIGY HOME HEALTH & HOSPICE CARE LLC
Entity Type:Organization
Organization Name:PRODIGY HOME HEALTH & HOSPICE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:AKWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-806-3840
Mailing Address - Street 1:793 BOSLEY
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0227
Mailing Address - Country:US
Mailing Address - Phone:408-806-3840
Mailing Address - Fax:
Practice Address - Street 1:793 BOSLEY
Practice Address - Street 2:
Practice Address - City:FATE
Practice Address - State:TX
Practice Address - Zip Code:75087-0227
Practice Address - Country:US
Practice Address - Phone:408-806-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health