Provider Demographics
NPI:1285065813
Name:ALLY HOME HEALTH LLC
Entity type:Organization
Organization Name:ALLY HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:LAVA
Authorized Official - Last Name:FAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-363-2559
Mailing Address - Street 1:5430 GLEN LAKES DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4362
Mailing Address - Country:US
Mailing Address - Phone:214-363-2559
Mailing Address - Fax:866-540-1396
Practice Address - Street 1:5430 GLEN LAKES DR
Practice Address - Street 2:SUITE 260
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4362
Practice Address - Country:US
Practice Address - Phone:214-363-2559
Practice Address - Fax:866-540-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2013-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health