Healthcare Provider Details

I. General information

NPI: 1295408854
Provider Name (Legal Business Name): C & D PEDIATRIC HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 TIGRIS TRL
MESQUITE TX
75181-1572
US

IV. Provider business mailing address

1708 TIGRIS TRL
MESQUITE TX
75181-1572
US

V. Phone/Fax

Practice location:
  • Phone: 469-363-6534
  • Fax: 972-584-1708
Mailing address:
  • Phone: 469-363-6534
  • Fax: 972-584-1708

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA HIPOLITO
Title or Position: DIRECTOR
Credential:
Phone: 693-636-5344