Provider Demographics
NPI:1831375070
Name:FORTUNE EZEOHA AND LINDA EZEOHA
Entity type:Organization
Organization Name:FORTUNE EZEOHA AND LINDA EZEOHA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FORTUNE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEOHA
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:214-694-6940
Mailing Address - Street 1:1206 BAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7806
Mailing Address - Country:US
Mailing Address - Phone:972-202-6633
Mailing Address - Fax:972-202-6633
Practice Address - Street 1:310 PARKER RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7243
Practice Address - Country:US
Practice Address - Phone:214-694-6940
Practice Address - Fax:972-202-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747322Medicare Oscar/Certification