Healthcare Provider Details

I. General information

NPI: 1841210317
Provider Name (Legal Business Name): PTM HEALTHCARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W.AIRPORT FRWY SUITE 530
IRVING TX
75062-6277
US

IV. Provider business mailing address

800 W AIRPORT FWY SUITE 530
IRVING TX
75062-6312
US

V. Phone/Fax

Practice location:
  • Phone: 972-257-6564
  • Fax: 972-257-6569
Mailing address:
  • Phone: 972-257-6564
  • Fax: 972-257-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number009768
License Number StateTX

VIII. Authorized Official

Name: MRS. CHRISTIANA IDAGHOMO IKHILE
Title or Position: ASSISTANT ADMINISTRATOR
Credential: ASCP
Phone: 972-257-6564