Provider Demographics
NPI:1821395351
Name:MEGASTAR HOME HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:MEGASTAR HOME HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAJU
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTAKKATTIL JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-235-7100
Mailing Address - Street 1:3235 N MESQUITE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4044
Mailing Address - Country:US
Mailing Address - Phone:972-235-7100
Mailing Address - Fax:972-235-7101
Practice Address - Street 1:3235 N MESQUITE DR STE 300
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4044
Practice Address - Country:US
Practice Address - Phone:972-235-7100
Practice Address - Fax:972-235-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 385H00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care