Provider Demographics
NPI:1417064619
Name:EMRICK SERVICES INCORPORATED
Entity type:Organization
Organization Name:EMRICK SERVICES INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-494-5444
Mailing Address - Street 1:6317 SAN MARINO DRIVE,
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089
Mailing Address - Country:US
Mailing Address - Phone:972-494-5444
Mailing Address - Fax:972-494-2331
Practice Address - Street 1:1919 S. SHILOH ROAD
Practice Address - Street 2:SUITE 540
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-8212
Practice Address - Country:US
Practice Address - Phone:972-494-5444
Practice Address - Fax:972-494-2331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010679251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201676801Medicaid
TX010679OtherAGENCY STATE LICENSE