Provider Demographics
NPI:1760714638
Name:RAYDON MUTUAL HOLDINGS CORPORATION
Entity Type:Organization
Organization Name:RAYDON MUTUAL HOLDINGS CORPORATION
Other - Org Name:RAYDON HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONAVAN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:972-765-4440
Mailing Address - Street 1:6212 SAMUELL BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7119
Mailing Address - Country:US
Mailing Address - Phone:972-765-4440
Mailing Address - Fax:972-220-9518
Practice Address - Street 1:6212 SAMUELL BLVD
Practice Address - Street 2:STE 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7119
Practice Address - Country:US
Practice Address - Phone:972-765-4440
Practice Address - Fax:972-220-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health