Provider Demographics
NPI:1972955920
Name:MARIPOSA POINT HOME HEALTH, LLC
Entity type:Organization
Organization Name:MARIPOSA POINT HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-619-5418
Mailing Address - Street 1:6370 LBJ FWY
Mailing Address - Street 2:SUITE 276
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6459
Mailing Address - Country:US
Mailing Address - Phone:469-619-5372
Mailing Address - Fax:
Practice Address - Street 1:8370 E VIA DE VENTURA
Practice Address - Street 2:SUITE K-150
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3179
Practice Address - Country:US
Practice Address - Phone:469-619-5418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health