Provider Demographics
NPI:1750614210
Name:BASIC HOMEHEALTH LLC
Entity type:Organization
Organization Name:BASIC HOMEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:NYANKIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-412-2192
Mailing Address - Street 1:2942 ALOUETTE DR
Mailing Address - Street 2:SUITE 523
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8141
Mailing Address - Country:US
Mailing Address - Phone:214-412-2192
Mailing Address - Fax:214-412-2192
Practice Address - Street 1:2942 ALOUETTE DR
Practice Address - Street 2:SUITE 523
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8141
Practice Address - Country:US
Practice Address - Phone:214-412-2192
Practice Address - Fax:214-412-2192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health