Provider Demographics
NPI:1295810620
Name:PASSIONATE CARE HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:PASSIONATE CARE HOME HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:EYANGBON
Authorized Official - Last Name:AGUEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-234-1600
Mailing Address - Street 1:9696 SKILLMAN ST STE 385
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8336
Mailing Address - Country:US
Mailing Address - Phone:972-234-1600
Mailing Address - Fax:972-234-1601
Practice Address - Street 1:9696 SKILLMAN ST STE 385
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8336
Practice Address - Country:US
Practice Address - Phone:972-234-1600
Practice Address - Fax:972-234-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010082251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010082OtherHCSSA LICENSE NUMBER
TX010082OtherHCSSA LICENSE NUMBER