Provider Demographics
NPI:1922280221
Name:CANNULIF HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:CANNULIF HEALTHCARE SERVICES, INC.
Other - Org Name:SANTA MARIA HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-503-8941
Mailing Address - Street 1:11500 N. STEMMONS FREEWAY
Mailing Address - Street 2:SUITE #133
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229
Mailing Address - Country:US
Mailing Address - Phone:214-503-8941
Mailing Address - Fax:214-503-8955
Practice Address - Street 1:11500 N. STEMMONS FREEWAY
Practice Address - Street 2:SUITE #133
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229
Practice Address - Country:US
Practice Address - Phone:214-503-8941
Practice Address - Fax:214-503-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1922280221Medicaid