Provider Demographics
NPI:1699710582
Name:CLEAN HEART HOME HEALTH CARE INC
Entity type:Organization
Organization Name:CLEAN HEART HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KIPKORIR
Authorized Official - Last Name:MUNAI
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:469-522-5123
Mailing Address - Street 1:2695 VILLA CREEK DR
Mailing Address - Street 2:147
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2695 VILLA CREEK DR
Practice Address - Street 2:147
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7328
Practice Address - Country:US
Practice Address - Phone:469-522-5123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX457887251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457887Medicare ID - Type Unspecified