1427147610 NPI number — LIBBYS HEALTHCARE MANAGEMENT,INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427147610 NPI number — LIBBYS HEALTHCARE MANAGEMENT,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBBYS HEALTHCARE MANAGEMENT,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LIBBYS HOME HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427147610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12000 FORD RD STE A120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-7249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-342-1487
Provider Business Mailing Address Fax Number:
469-372-1244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12000 FORD ST.
Provider Second Line Business Practice Location Address:
SUITEA-120
Provider Business Practice Location Address City Name:
FARMERS BRANCH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-342-1487
Provider Business Practice Location Address Fax Number:
469-372-1244
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
IN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
469-372-1487

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  007387 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 224-17-2401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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