Healthcare Provider Details

I. General information

NPI: 1174069017
Provider Name (Legal Business Name): AETNA HOME CARE & MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12989 JUPITER RD STE 104
DALLAS TX
75238-5248
US

IV. Provider business mailing address

12989 JUPITER RD STE 104
DALLAS TX
75238-5248
US

V. Phone/Fax

Practice location:
  • Phone: 682-381-9632
  • Fax: 682-316-0058
Mailing address:
  • Phone: 682-381-9632
  • Fax: 682-316-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateTX

VIII. Authorized Official

Name: PATIENCE AKPANDEM
Title or Position: OWNER
Credential:
Phone: 682-381-9632