Provider Demographics
NPI:1396760054
Name:IMPARTING KNOWLEDGE HOME HEALTH LLC
Entity type:Organization
Organization Name:IMPARTING KNOWLEDGE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOENEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-664-0945
Mailing Address - Street 1:1255 W 15TH ST STE 900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4214
Mailing Address - Country:US
Mailing Address - Phone:972-664-0945
Mailing Address - Fax:972-664-0139
Practice Address - Street 1:1255 W 15TH ST STE 900
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4214
Practice Address - Country:US
Practice Address - Phone:972-664-0945
Practice Address - Fax:972-664-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX017670251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2080103Medicaid
TX2080103Medicaid