Provider Demographics
NPI:1841210317
Name:PTM HEALTHCARE SERVICES INC.
Entity type:Organization
Organization Name:PTM HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:IDAGHOMO
Authorized Official - Last Name:IKHILE
Authorized Official - Suffix:
Authorized Official - Credentials:ASCP
Authorized Official - Phone:972-257-6564
Mailing Address - Street 1:800 W AIRPORT FWY
Mailing Address - Street 2:SUITE 530
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-6312
Mailing Address - Country:US
Mailing Address - Phone:972-257-6564
Mailing Address - Fax:972-257-6569
Practice Address - Street 1:800 W.AIRPORT FRWY
Practice Address - Street 2:SUITE 530
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6277
Practice Address - Country:US
Practice Address - Phone:972-257-6564
Practice Address - Fax:972-257-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009768251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677862Medicare Oscar/Certification