Provider Demographics
NPI:1790360360
Name:AETNA HOME HEALTH CARE AND MANAGEMENT LLC
Entity type:Organization
Organization Name:AETNA HOME HEALTH CARE AND MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPANDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-381-9632
Mailing Address - Street 1:12989 JUPITER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5248
Mailing Address - Country:US
Mailing Address - Phone:682-381-9632
Mailing Address - Fax:682-316-0058
Practice Address - Street 1:12989 JUPITER RD STE 103
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5248
Practice Address - Country:US
Practice Address - Phone:682-381-9632
Practice Address - Fax:682-316-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX423277901Medicaid