Provider Demographics
NPI:1740537893
Name:DEGAURDIAN HEALTH AGENCY, INC
Entity type:Organization
Organization Name:DEGAURDIAN HEALTH AGENCY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOKOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-688-3631
Mailing Address - Street 1:1507 LONESOME DOVE TRL
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7983
Mailing Address - Country:US
Mailing Address - Phone:469-688-3631
Mailing Address - Fax:469-298-0395
Practice Address - Street 1:1507 LONESOME DOVE TRL
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7983
Practice Address - Country:US
Practice Address - Phone:469-688-3631
Practice Address - Fax:469-298-0395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEGUARDIAN HEALTH AGENCY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-08
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
TX015361251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health