Provider Demographics
NPI:1134905854
Name:FIFTY PLUS PROVIDER SERVICES
Entity type:Organization
Organization Name:FIFTY PLUS PROVIDER SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAJARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-595-2400
Mailing Address - Street 1:3200 BROADWAY BLVD STE 268
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1572
Mailing Address - Country:US
Mailing Address - Phone:903-595-2400
Mailing Address - Fax:903-595-2415
Practice Address - Street 1:3200 BROADWAY BLVD STE 268
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1572
Practice Address - Country:US
Practice Address - Phone:903-595-2400
Practice Address - Fax:903-595-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health