Provider Demographics
NPI:1902196546
Name:DERA HEALTHCARE SYSTEM INC.
Entity Type:Organization
Organization Name:DERA HEALTHCARE SYSTEM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:LOUISA
Authorized Official - Last Name:UZOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-223-9955
Mailing Address - Street 1:628 SNAPDRAGON LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6658
Mailing Address - Country:US
Mailing Address - Phone:972-223-9955
Mailing Address - Fax:972-223-9955
Practice Address - Street 1:628 SNAPDRAGON LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6658
Practice Address - Country:US
Practice Address - Phone:972-223-9955
Practice Address - Fax:972-223-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-16
Last Update Date:2011-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health