Provider Demographics
NPI:1104174259
Name:ONEONONECARESITTER
Entity type:Organization
Organization Name:ONEONONECARESITTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEDRA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-977-0311
Mailing Address - Street 1:618 NORTHILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5112
Mailing Address - Country:US
Mailing Address - Phone:972-977-0311
Mailing Address - Fax:
Practice Address - Street 1:618 NORTHILL DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5112
Practice Address - Country:US
Practice Address - Phone:972-977-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OWNER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicare UPIN