Healthcare Provider Details

I. General information

NPI: 1942255591
Provider Name (Legal Business Name): FIRST IN PEDIATRICS HOME HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N WALNUT ST
JEFFERSON TX
75657-1934
US

IV. Provider business mailing address

120 N WALNUT ST
JEFFERSON TX
75657-1934
US

V. Phone/Fax

Practice location:
  • Phone: 903-665-6131
  • Fax: 903-665-7244
Mailing address:
  • Phone: 903-665-6131
  • Fax: 903-665-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number008366
License Number StateTX

VIII. Authorized Official

Name: SHARON BONNER
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-665-6131