Provider Demographics
NPI:1063599264
Name:MARVELOUS CHOICE HOME HEALTH, INC
Entity type:Organization
Organization Name:MARVELOUS CHOICE HOME HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR DIRECTOR OF NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEKWUWA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-324-9099
Mailing Address - Street 1:8035 E RL THRTN FWY STE 452
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-1016
Mailing Address - Country:US
Mailing Address - Phone:214-324-9099
Mailing Address - Fax:214-324-3090
Practice Address - Street 1:8035 E RL THRTN FWY STE 452
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-1016
Practice Address - Country:US
Practice Address - Phone:214-324-9099
Practice Address - Fax:214-324-3090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
011933251E00000X
TX011933251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-7896Medicare ID - Type UnspecifiedHOME HEALTH
677896Medicare Oscar/Certification