Provider Demographics
NPI:1073713244
Name:PRESTONWOOD HOME HEALTH OF FORT WORTH INC
Entity type:Organization
Organization Name:PRESTONWOOD HOME HEALTH OF FORT WORTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ALT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBOLUGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-230-8374
Mailing Address - Street 1:6468 BRENTWOOD STAIR RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76112-3228
Mailing Address - Country:US
Mailing Address - Phone:817-230-8374
Mailing Address - Fax:817-294-0338
Practice Address - Street 1:6468 BRENTWOOD STAIR RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76112-3228
Practice Address - Country:US
Practice Address - Phone:817-230-8374
Practice Address - Fax:817-294-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 3747A0650X, 3747P1801X, 374U00000X
TX011459251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747094Medicare Oscar/Certification