Provider Demographics
NPI:1386883064
Name:PRINCEWILL HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:PRINCEWILL HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-886-8631
Mailing Address - Street 1:4100 MEDICAL PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-1538
Mailing Address - Country:US
Mailing Address - Phone:972-727-0784
Mailing Address - Fax:972-727-0792
Practice Address - Street 1:4100 MEDICAL PKWY STE 250
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-1538
Practice Address - Country:US
Practice Address - Phone:972-727-0784
Practice Address - Fax:972-727-0792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251E00000XMedicaid
TX282425201Medicaid
TX3747P1801XMedicaid