1427147610 NPI number — LIBBYS HEALTHCARE MANAGEMENT,INC

Table of content: (NPI 1427147610)

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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