Provider Demographics
NPI:1861458887
Name:METROCREST HEALTH INC
Entity Type:Organization
Organization Name:METROCREST HEALTH INC
Other - Org Name:METROSTAR HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:ULOMA
Authorized Official - Last Name:NDIULOR
Authorized Official - Suffix:
Authorized Official - Credentials:DON RN
Authorized Official - Phone:972-263-7373
Mailing Address - Street 1:2304 OAK LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051
Mailing Address - Country:US
Mailing Address - Phone:972-263-7373
Mailing Address - Fax:972-266-7344
Practice Address - Street 1:2304 OAK LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051
Practice Address - Country:US
Practice Address - Phone:972-263-7373
Practice Address - Fax:972-266-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009876251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679101Medicare ID - Type Unspecified