Provider Demographics
NPI:1396980132
Name:HEALING POOL HEALTHCARE AGENCY
Entity type:Organization
Organization Name:HEALING POOL HEALTHCARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYAWE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,APRN,FNP-BC,FNP-
Authorized Official - Phone:214-440-7151
Mailing Address - Street 1:372 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5119
Mailing Address - Country:US
Mailing Address - Phone:214-440-7151
Mailing Address - Fax:844-834-1906
Practice Address - Street 1:372 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5119
Practice Address - Country:US
Practice Address - Phone:214-440-7151
Practice Address - Fax:844-834-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherMEDICARE NUMBERS PENDING