Provider Demographics
NPI:1881199024
Name:PEDIATRIC HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HOSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:972-630-4811
Mailing Address - Street 1:1341 W MOCKINGBIRD LN # 780W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-6913
Mailing Address - Country:US
Mailing Address - Phone:972-630-4811
Mailing Address - Fax:
Practice Address - Street 1:8501 N MOPAC EXPY STE 410
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:972-630-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC HOME HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health