Provider Demographics
NPI:1104070747
Name:MOLLYKUTTY C. THOMAS
Entity type:Organization
Organization Name:MOLLYKUTTY C. THOMAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOLLYKUTTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-951-4086
Mailing Address - Street 1:5434 OAKMONT LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-6519
Mailing Address - Country:US
Mailing Address - Phone:469-951-4086
Mailing Address - Fax:972-203-1270
Practice Address - Street 1:5434 OAKMONT LN
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-6519
Practice Address - Country:US
Practice Address - Phone:469-951-4086
Practice Address - Fax:972-203-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health