Provider Demographics
NPI:1891744033
Name:INTERIM HEALTHCARE OF DALLAS LP
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF DALLAS LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-9933
Mailing Address - Street 1:12750 MERIT DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1214
Mailing Address - Country:US
Mailing Address - Phone:214-360-9090
Mailing Address - Fax:214-987-4384
Practice Address - Street 1:12750 MERIT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-1214
Practice Address - Country:US
Practice Address - Phone:214-360-9090
Practice Address - Fax:214-987-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7640251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1623449-01Medicaid
TX7640OtherSTATE LICENCE NUMBER
679384Medicare ID - Type Unspecified