Provider Demographics
NPI:1992963318
Name:PALOMA HOME HEALTH AGENCY INC.
Entity type:Organization
Organization Name:PALOMA HOME HEALTH AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICODEMUS
Authorized Official - Middle Name:ODHIAMBO
Authorized Official - Last Name:OBUYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-346-2013
Mailing Address - Street 1:PO BOX 700694
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-0694
Mailing Address - Country:US
Mailing Address - Phone:972-346-2013
Mailing Address - Fax:972-853-7085
Practice Address - Street 1:13601 PRESTON RD
Practice Address - Street 2:SUITE 225E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4911
Practice Address - Country:US
Practice Address - Phone:972-346-2013
Practice Address - Fax:972-853-7085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012184251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012184OtherTEXAS STATE LICENSE
TX012184OtherTEXAS STATE LICENSE