Provider Demographics
NPI:1265730279
Name:MANCHESTER SERVICES HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:MANCHESTER SERVICES HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASOVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-247-2228
Mailing Address - Street 1:2454 GLENDA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-4511
Mailing Address - Country:US
Mailing Address - Phone:972-247-2228
Mailing Address - Fax:972-241-5889
Practice Address - Street 1:2454 GLENDA LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-4511
Practice Address - Country:US
Practice Address - Phone:972-247-2228
Practice Address - Fax:972-241-5889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health