Healthcare Provider Details

I. General information

NPI: 1699235606
Provider Name (Legal Business Name): JOSHUA'S HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11880 SHILOH RD
DALLAS TX
75228-1501
US

IV. Provider business mailing address

11880 SHILOH RD
DALLAS TX
75228-1501
US

V. Phone/Fax

Practice location:
  • Phone: 469-916-9354
  • Fax: 469-916-9358
Mailing address:
  • Phone: 469-916-9354
  • Fax: 469-916-9358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JACOB CHARLES BOSWELL
Title or Position: PRESIDENT
Credential:
Phone: 214-403-8323