Provider Demographics
NPI:1669915419
Name:TEXAS PREMIUM HOME CARE CORP.
Entity type:Organization
Organization Name:TEXAS PREMIUM HOME CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-999-8224
Mailing Address - Street 1:2705 SUMMERTREE LN
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5139
Mailing Address - Country:US
Mailing Address - Phone:205-999-8224
Mailing Address - Fax:
Practice Address - Street 1:2705 SUMMERTREE LN
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5139
Practice Address - Country:US
Practice Address - Phone:205-999-8224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care