Healthcare Provider Details

I. General information

NPI: 1023315801
Provider Name (Legal Business Name): EMPOWERED HOME HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 TAYLOR DR
MESQUITE TX
75149-6958
US

IV. Provider business mailing address

1532 TAYLOR DR
MESQUITE TX
75149-6958
US

V. Phone/Fax

Practice location:
  • Phone: 214-295-4324
  • Fax: 214-295-4397
Mailing address:
  • Phone: 214-295-4324
  • Fax: 214-295-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number013577
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number013577
License Number StateTX

VIII. Authorized Official

Name: MR. CHARLES UDO ENYINNA-OKEIGBO
Title or Position: ADMINISTRATOR/SUPERVISING NURSE
Credential: REGISTERED NURSE
Phone: 972-814-3332