Provider Demographics
NPI:1720492937
Name:AXXESS HEALTHCARE PROVIDER
Entity Type:Organization
Organization Name:AXXESS HEALTHCARE PROVIDER
Other - Org Name:AXXESS HEALTHCARE PROVIDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ROMANDA
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-693-0596
Mailing Address - Street 1:4100 BROADWAY AVE APT 12304
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-7583
Mailing Address - Country:US
Mailing Address - Phone:469-693-0596
Mailing Address - Fax:469-675-6225
Practice Address - Street 1:4100 BROADWAY AVE APT 12304
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7583
Practice Address - Country:US
Practice Address - Phone:469-693-0596
Practice Address - Fax:469-675-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX759980251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care