Provider Demographics
NPI:1063593226
Name:SSQ HOME HEALTH CARE,INC
Entity type:Organization
Organization Name:SSQ HOME HEALTH CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-333-4499
Mailing Address - Street 1:4445 CORNER BROOK LANE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123
Mailing Address - Country:US
Mailing Address - Phone:817-333-4499
Mailing Address - Fax:817-297-8936
Practice Address - Street 1:4445 CORNER BROOK LANE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123
Practice Address - Country:US
Practice Address - Phone:817-333-4499
Practice Address - Fax:817-297-8936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011055251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679784Medicare Oscar/Certification