Provider Demographics
NPI:1932325727
Name:G12 HEALTHPOINT SERVICES
Entity Type:Organization
Organization Name:G12 HEALTHPOINT SERVICES
Other - Org Name:DOMINION HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:OKECHUKWU
Authorized Official - Last Name:NWOKORIE
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:972-748-8009
Mailing Address - Street 1:1165 CALVERT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2303
Mailing Address - Country:US
Mailing Address - Phone:972-748-8009
Mailing Address - Fax:972-291-7520
Practice Address - Street 1:1165 CALVERT DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2303
Practice Address - Country:US
Practice Address - Phone:972-748-8009
Practice Address - Fax:972-291-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011118251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health