Provider Demographics
NPI:1255589834
Name:FARMINGTON PLACE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:FARMINGTON PLACE HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:OLUGBOLAHAN
Authorized Official - Last Name:OGUNDIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-221-0020
Mailing Address - Street 1:11325 PEGASUS ST S-142
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5239
Mailing Address - Country:US
Mailing Address - Phone:214-221-0020
Mailing Address - Fax:
Practice Address - Street 1:11325 PEGASUS ST # S-142
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5239
Practice Address - Country:US
Practice Address - Phone:214-221-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9059251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9059OtherTEXAS HCSSA LICENSE #