Provider Demographics
NPI:1255914487
Name:ESSENTIAL CARE HOME HEALTH LLC
Entity type:Organization
Organization Name:ESSENTIAL CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK-O
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-908-9079
Mailing Address - Street 1:6725 TAWNY OAK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5507
Mailing Address - Country:US
Mailing Address - Phone:408-908-9079
Mailing Address - Fax:469-395-0409
Practice Address - Street 1:6725 TAWNY OAK DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5507
Practice Address - Country:US
Practice Address - Phone:408-908-9079
Practice Address - Fax:469-395-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802932494OtherSECRETARY OF STATE CERTIFICATE OF FILING