Provider Demographics
NPI:1538248877
Name:HOME CARE ETC
Entity type:Organization
Organization Name:HOME CARE ETC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OMORAGBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-974-6141
Mailing Address - Street 1:PO BOX 2150
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75030-2150
Mailing Address - Country:US
Mailing Address - Phone:214-415-7369
Mailing Address - Fax:469-366-3520
Practice Address - Street 1:2110 HILLSIDE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-1514
Practice Address - Country:US
Practice Address - Phone:972-974-6141
Practice Address - Fax:469-366-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010877251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010877OtherHOME CARE LICENSE