Provider Demographics
NPI:1396074332
Name:PROHEALTH HOUSE CALLS SERVICES INC.
Entity type:Organization
Organization Name:PROHEALTH HOUSE CALLS SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ETTA
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC
Authorized Official - Phone:972-900-7222
Mailing Address - Street 1:2300 ROCKBROOK DR
Mailing Address - Street 2:SUITE 222
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8181
Mailing Address - Country:US
Mailing Address - Phone:469-293-3676
Mailing Address - Fax:469-293-3704
Practice Address - Street 1:2300 ROCKBROOK DR
Practice Address - Street 2:SUITE 222
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8181
Practice Address - Country:US
Practice Address - Phone:469-293-3676
Practice Address - Fax:469-293-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662521363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211014001Medicaid
TX0A5708Medicare PIN