Provider Demographics
NPI:1013524131
Name:IOCCK HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:IOCCK HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:IFEANYI
Authorized Official - Middle Name:
Authorized Official - Last Name:DURUEWURU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:214-906-5427
Mailing Address - Street 1:2875 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8518
Mailing Address - Country:US
Mailing Address - Phone:214-906-5427
Mailing Address - Fax:
Practice Address - Street 1:2875 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8518
Practice Address - Country:US
Practice Address - Phone:214-906-5427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251E00000XAgenciesHome Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility