Provider Demographics
NPI:1811075898
Name:MANSIN HEALTHCARE PROVIDER INC
Entity type:Organization
Organization Name:MANSIN HEALTHCARE PROVIDER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:ESIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-271-0675
Mailing Address - Street 1:3228 SOUTHERN DRIVE
Mailing Address - Street 2:SUITE 204 B
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043
Mailing Address - Country:US
Mailing Address - Phone:972-271-0675
Mailing Address - Fax:972-926-9574
Practice Address - Street 1:3228 SOUTHERN DRIVE
Practice Address - Street 2:SUITE 204 B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043
Practice Address - Country:US
Practice Address - Phone:972-271-0675
Practice Address - Fax:972-926-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
TX009897251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679549Medicare Oscar/Certification