Provider Demographics
NPI:1750443149
Name:DYNA CARE HOUSTON LLC
Entity Type:Organization
Organization Name:DYNA CARE HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABITURAB
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-560-2925
Mailing Address - Street 1:4800 W 129TH ST
Mailing Address - Street 2:
Mailing Address - City:ALSIP
Mailing Address - State:IL
Mailing Address - Zip Code:60803-3016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8203 WILLOW PLACE DR S
Practice Address - Street 2:SUITE 405
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5655
Practice Address - Country:US
Practice Address - Phone:832-237-2552
Practice Address - Fax:832-237-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008438251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid
TX=========Medicaid