Provider Demographics
NPI:1770648313
Name:DYNA CARE HOME HEALTH - HOUSTON, LLC
Entity Type:Organization
Organization Name:DYNA CARE HOME HEALTH - HOUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABI
Authorized Official - Middle Name:TURAB
Authorized Official - Last Name:BOXWALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-560-7200
Mailing Address - Street 1:18454 W WEST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-6273
Mailing Address - Country:US
Mailing Address - Phone:708-560-7200
Mailing Address - Fax:708-560-7350
Practice Address - Street 1:704 N THOMPSON ST
Practice Address - Street 2:SUITE 158
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2578
Practice Address - Country:US
Practice Address - Phone:936-760-1345
Practice Address - Fax:936-760-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
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
67-9334Medicare ID - Type Unspecified