Provider Demographics
NPI:1841492683
Name:EMINENT HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:EMINENT HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALSAMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-660-4404
Mailing Address - Street 1:10864 AUDELIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1068
Mailing Address - Country:US
Mailing Address - Phone:214-660-4404
Mailing Address - Fax:214-660-4406
Practice Address - Street 1:10864 AUDELIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-1068
Practice Address - Country:US
Practice Address - Phone:214-660-4404
Practice Address - Fax:214-660-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009960251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677937Medicare PIN