Provider Demographics
NPI:1306593306
Name:DOMINION HOME HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:DOMINION HOME HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEREMI
Authorized Official - Middle Name:A
Authorized Official - Last Name:JUNAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-451-8727
Mailing Address - Street 1:733 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-0287
Mailing Address - Country:US
Mailing Address - Phone:214-451-8727
Mailing Address - Fax:
Practice Address - Street 1:733 EDINBURGH DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-0287
Practice Address - Country:US
Practice Address - Phone:214-451-8727
Practice Address - Fax:469-519-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2023-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306593306Medicaid