Provider Demographics
NPI:1306801139
Name:MACBON HOME HEALTH INC
Entity type:Organization
Organization Name:MACBON HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:OGBENNAH
Authorized Official - Last Name:GINIGEME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-346-1965
Mailing Address - Street 1:1720 S EDMONDS LN
Mailing Address - Street 2:STE 14
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5805
Mailing Address - Country:US
Mailing Address - Phone:214-346-1965
Mailing Address - Fax:214-346-1980
Practice Address - Street 1:1720 S EDMONDS LN
Practice Address - Street 2:STE 14
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5805
Practice Address - Country:US
Practice Address - Phone:214-346-1965
Practice Address - Fax:214-346-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009067251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
673174Medicare ID - Type Unspecified