Provider Demographics
NPI:1083917546
Name:PROXIMAL HOME HEALTHCARE INC
Entity type:Organization
Organization Name:PROXIMAL HOME HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OHOME
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:336-210-5211
Mailing Address - Street 1:5701 BRYAN PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-8109
Mailing Address - Country:US
Mailing Address - Phone:214-253-2558
Mailing Address - Fax:214-253-2559
Practice Address - Street 1:5701 BRYAN PKWY STE C
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-8109
Practice Address - Country:US
Practice Address - Phone:214-253-2558
Practice Address - Fax:214-253-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747805Medicare PIN