Provider Demographics
NPI:1649676859
Name:THUNDER HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:THUNDER HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TSHIAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-735-0194
Mailing Address - Street 1:13805 GREEN HOOK RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-1700
Mailing Address - Country:US
Mailing Address - Phone:469-735-0194
Mailing Address - Fax:682-200-2635
Practice Address - Street 1:13805 GREEN HOOK RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-1700
Practice Address - Country:US
Practice Address - Phone:469-735-0194
Practice Address - Fax:682-200-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX0166543747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026842Medicaid