Healthcare Provider Details

I. General information

NPI: 1891460325
Provider Name (Legal Business Name): AVISTAR HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 SPINKS RD STE 133
FLOWER MOUND TX
75022-4451
US

IV. Provider business mailing address

1517 CAYMUS CT
LEWISVILLE TX
75067-3254
US

V. Phone/Fax

Practice location:
  • Phone: 214-430-0996
  • Fax: 833-414-0604
Mailing address:
  • Phone: 214-430-0996
  • Fax: 833-414-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ROSE EFESOA
Title or Position: ADMINISTRATOR ASSISTANT
Credential:
Phone: 214-430-0996