Provider Demographics
NPI:1427676915
Name:KURUVILA, PUTHENVEETTIL (ALL STAR HOME HEALTH)
Entity type:Individual
Prefix:
First Name:PUTHENVEETTIL
Middle Name:
Last Name:KURUVILA
Suffix:
Gender:M
Credentials:ALL STAR HOME HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-8819
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2410 LUNA RD STE 206
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6538
Practice Address - Country:US
Practice Address - Phone:972-740-3417
Practice Address - Fax:972-870-5512
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747571Medicaid