Provider Demographics
NPI:1972006492
Name:ANDOVER HOME HEALTH CARE,LLC
Entity Type:Organization
Organization Name:ANDOVER HOME HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BWISA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-851-4172
Mailing Address - Street 1:2012 PIEDMONT DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-7898
Mailing Address - Country:US
Mailing Address - Phone:817-851-4172
Mailing Address - Fax:
Practice Address - Street 1:2012 PIEDMONT DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-7898
Practice Address - Country:US
Practice Address - Phone:817-851-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-11
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty