1144590274 NPI number — ABSOLUTE CARE HOME HEALTHCARE, LLC

Table of content: (NPI 1144590274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144590274 NPI number — ABSOLUTE CARE HOME HEALTHCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABSOLUTE CARE HOME HEALTHCARE, LLC
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:
Provider Other Organization Name Type Code:
6
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:
1144590274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2616 ASPEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-4780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-600-0039
Provider Business Mailing Address Fax Number:
214-227-2028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6653 MCKINNEY RANCH PKWY APT 10305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-2222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-600-0039
Provider Business Practice Location Address Fax Number:
214-227-2028
Provider Enumeration Date:
01/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FAGBILE
Authorized Official First Name:
OMOWUNMI
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ADMINISTRATOR/CFO
Authorized Official Telephone Number:
214-600-0039

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  015506 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 015506 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015506 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".