Provider Demographics
NPI:1194070524
Name:DEROSSY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:DEROSSY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTINS
Authorized Official - Middle Name:ONYEMAECHI
Authorized Official - Last Name:NWAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:651-468-9617
Mailing Address - Street 1:20930 FLOWER CROFT CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-4488
Mailing Address - Country:US
Mailing Address - Phone:651-468-9617
Mailing Address - Fax:
Practice Address - Street 1:20930 FLOWER CROFT CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-4488
Practice Address - Country:US
Practice Address - Phone:651-468-9617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEROSSY HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX714722251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care