Provider Demographics
NPI:1801817846
Name:BALM IN GILEAD HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:BALM IN GILEAD HOME HEALTH SERVICES, INC.
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-561-9419
Mailing Address - Street 1:4546 SOUTH BROADWAY AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703
Mailing Address - Country:US
Mailing Address - Phone:903-561-9419
Mailing Address - Fax:903-561-2633
Practice Address - Street 1:4546 S. BROADWAY AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703
Practice Address - Country:US
Practice Address - Phone:903-561-9419
Practice Address - Fax:903-561-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010346251E00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010346Medicare UPIN
TX679545Medicare Oscar/Certification
679545Medicare Oscar/Certification