Provider Demographics
NPI:1528107992
Name:FIRST ATLANTIC HOMECARE SERVICES CORPORATION
Entity type:Organization
Organization Name:FIRST ATLANTIC HOMECARE SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER ALT ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:OBBY
Authorized Official - Middle Name:O O
Authorized Official - Last Name:NWABUKO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-773-6020
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503
Mailing Address - Country:US
Mailing Address - Phone:254-773-6020
Mailing Address - Fax:254-773-6080
Practice Address - Street 1:619 N 3RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-3156
Practice Address - Country:US
Practice Address - Phone:254-773-6020
Practice Address - Fax:254-773-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009511251E00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
457947Medicare ID - Type Unspecified