Provider Demographics
NPI:1356731376
Name:PF TOTAL ADULT & BEAUTY HEALTH AGENCY
Entity type:Organization
Organization Name:PF TOTAL ADULT & BEAUTY HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARQUITA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-747-5736
Mailing Address - Street 1:11408 HWY 64 W
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-6928
Mailing Address - Country:US
Mailing Address - Phone:903-747-5736
Mailing Address - Fax:
Practice Address - Street 1:11408 HWY 64 W
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75704-6928
Practice Address - Country:US
Practice Address - Phone:903-747-5736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health