Provider Demographics
NPI:1205905973
Name:CANDID HOME HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:CANDID HOME HEALTH CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:ENYERIBE
Authorized Official - Last Name:OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-879-0343
Mailing Address - Street 1:633 W CENTERVILLE RD STE 311
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5428
Mailing Address - Country:US
Mailing Address - Phone:214-879-0343
Mailing Address - Fax:214-879-0373
Practice Address - Street 1:633 W CENTERVILLE RD STE 311
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5428
Practice Address - Country:US
Practice Address - Phone:214-879-0343
Practice Address - Fax:214-879-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174184501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457811Medicare ID - Type Unspecified