Provider Demographics
NPI:1770842551
Name:COOK CHILDRENS HOME HEALTH
Entity Type:Organization
Organization Name:COOK CHILDRENS HOME HEALTH
Other - Org Name:ORTHOTIC PROSTHETIC PHY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CCHH
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-885-2409
Mailing Address - Street 1:1719 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1349
Mailing Address - Country:US
Mailing Address - Phone:682-885-6492
Mailing Address - Fax:682-885-1135
Practice Address - Street 1:1719 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1349
Practice Address - Country:US
Practice Address - Phone:682-885-6492
Practice Address - Fax:682-885-1135
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDRENS HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101295222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty