Provider Demographics
NPI:1932217734
Name:STATE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:STATE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:AGWAIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-333-9087
Mailing Address - Street 1:4650 S HAMPTON ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-1066
Mailing Address - Country:US
Mailing Address - Phone:214-333-9087
Mailing Address - Fax:214-333-9089
Practice Address - Street 1:4650 S HAMPTON ROAD
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-1066
Practice Address - Country:US
Practice Address - Phone:214-333-9087
Practice Address - Fax:214-333-9089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008117251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679235Medicare ID - Type Unspecified