Provider Demographics
NPI:1811380280
Name:PICACHE -MOLINA WWJD L.L.C.
Entity Type:Organization
Organization Name:PICACHE -MOLINA WWJD L.L.C.
Other - Org Name:COMFORCARE HOME CARE NORTH DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMONCITO
Authorized Official - Middle Name:MARIANO
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-955-8974
Mailing Address - Street 1:2016 RED ROCK DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3258
Mailing Address - Country:US
Mailing Address - Phone:214-592-0840
Mailing Address - Fax:214-592-0842
Practice Address - Street 1:1836 W VIRGINIA ST
Practice Address - Street 2:SUITE 104-A
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7865
Practice Address - Country:US
Practice Address - Phone:214-592-0840
Practice Address - Fax:214-592-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care