Basic Information
Provider Information | |||||||||
NPI: | 1144778846 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HOME HEALTH SPECIALISTS LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2140 JUSTIN RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | HIGHLAND VILLAGE | ||||||||
State: | TX | ||||||||
PostalCode: | 750777163 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2149086353 | ||||||||
FaxNumber: | 8774660075 | ||||||||
Practice Location | |||||||||
Address1: | 2140 JUSTIN RD STE 200 | ||||||||
Address2: |   | ||||||||
City: | HIGHLAND VILLAGE | ||||||||
State: | TX | ||||||||
PostalCode: | 750777163 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8774660050 | ||||||||
FaxNumber: | 8774660075 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2016 | ||||||||
LastUpdateDate: | 08/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | NEVILLE | ||||||||
AuthorizedOfficialFirstName: | ROB | ||||||||
AuthorizedOfficialMiddleName: | DALE | ||||||||
AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
AuthorizedOfficialTelephone: | 2149086353 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | OTR | ||||||||
NPICertificationDate: | 08/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X |   |   | Y |   | Agencies | Home Health |   |
No ID Information.