Healthcare Provider Details

I. General information

NPI: 1174690143
Provider Name (Legal Business Name): AZZA PROVIDER SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 NICOLE WAY
ARLINGTON TX
76002-2988
US

IV. Provider business mailing address

6501 NICOLE WAY
ARLINGTON TX
76002-2988
US

V. Phone/Fax

Practice location:
  • Phone: 817-703-8652
  • Fax: 817-467-2533
Mailing address:
  • Phone: 817-703-8652
  • Fax: 817-467-2533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010848
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: AGATHA OKOJIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-703-8652