MEDICARE: PC HOME HEALTH

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

General Provider Information

NPI Number	:	1598187130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PC HOME HEALTH

Provider Business Mailing Address
First Line	:	1155 WARRIOR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75253-5073
Country	:	US
Telephone Number	:	214-991-5619
Fax Number	:	214-484-2376

Provider Business Practice Location Address
First Line	:	1155 WARRIOR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75253-5073
Country	:	US
Telephone Number	:	214-991-5619
Fax Number	:	214-484-2376

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANTOINE MOURY'E BEACHUM
Credential	:	CMA
Telephone Number	:	214-991-5619

Provider Enumeration Date	:	01/16/2014
Last Update Date	:	01/16/2014

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Directions to “PC HOME HEALTH ” Practice Location

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