1295735439 NPI number — ANI HOME HEALTH AGENCY LTD CO

Table of content: (NPI 1295735439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295735439 NPI number — ANI HOME HEALTH AGENCY LTD CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANI HOME HEALTH AGENCY LTD CO
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:
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:
1295735439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 N HAMPTON RD
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-228-4100
Provider Business Mailing Address Fax Number:
972-228-4128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215A EXECUTIVE WAY
Provider Second Line Business Practice Location Address:
# 120
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-228-4100
Provider Business Practice Location Address Fax Number:
972-228-4128
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EDEGBELE
Authorized Official First Name:
ORITSEBEMIGHO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-228-4100

Provider Taxonomy Codes

  • Taxonomy code: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 007896 , 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: 01365146 . This is a "WELLPOINT AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1295735439 . This is a "AETNA BETTER HEALTH OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001021318 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295735439 . This is a "COOK CHILDREN'S HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: S50019732 . This is a "SUPERIOR HEALTHPLAN TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: QMP000003835502 . This is a "MOLINA HEALTHCARE OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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