Provider Demographics
NPI:1952371239
Name:COOK CHILDRENS HOME HEALTH
Entity Type:Organization
Organization Name:COOK CHILDRENS HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-885-2409
Mailing Address - Street 1:PO BOX 99283
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-1383
Mailing Address - Country:US
Mailing Address - Phone:682-885-6294
Mailing Address - Fax:682-885-1135
Practice Address - Street 1:1101 W VICKERY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1025
Practice Address - Country:US
Practice Address - Phone:682-885-6294
Practice Address - Fax:682-885-2499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOK CHILDREN'S HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2021-04-08
Deactivation Date:2007-02-26
Deactivation Code:
Reactivation Date:2008-12-01
Provider Licenses
StateLicense IDTaxonomies
251F00000X
TX20616333600000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079033901/RXMedicaid
TX068793101/CCPMedicaid
TX078914102/CSNMedicaid
TX068793101/CCPMedicaid
TX068793101MedicaidINDIVIDUAL TPI NUMBER