Healthcare Provider Details

I. General information

NPI: 1982283909
Provider Name (Legal Business Name): MOMENTUS HEALTH HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 W MOCKINGBIRD LN # 214W
DALLAS TX
75247-6913
US

IV. Provider business mailing address

1341 W MOCKINGBIRD LN # 214W
DALLAS TX
75247-6913
US

V. Phone/Fax

Practice location:
  • Phone: 214-310-0610
  • Fax: 866-740-7952
Mailing address:
  • Phone: 214-310-0610
  • Fax: 866-740-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVIS TORRAIN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 214-310-0610