MEDICARE: IDEAL HOME HEALTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	008166	TX

General Provider Information

NPI Number	:	1407916356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL HOME HEALTH, INC

Provider Business Mailing Address
First Line	:	2501 OAK LAWN AVE STE 275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4079
Country	:	US
Telephone Number	:	214-374-6800
Fax Number	:	214-374-6871

Provider Business Practice Location Address
First Line	:	2501 OAK LAWN AVE STE 275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-4079
Country	:	US
Telephone Number	:	214-374-6800
Fax Number	:	214-374-6871

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ELLEN S CLINTON
Credential	:
Telephone Number	:	214-374-6800

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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