Healthcare Provider Details

I. General information

NPI: 1982362232
Provider Name (Legal Business Name): ASSURED PEDIATRIC HOME HEALTH AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 US HIGHWAY 80 E STE 358A
MESQUITE TX
75150-3374
US

IV. Provider business mailing address

3939 US HIGHWAY 80 E STE 358A
MESQUITE TX
75150-3374
US

V. Phone/Fax

Practice location:
  • Phone: 405-923-9935
  • Fax: 281-095-5126
Mailing address:
  • Phone: 405-923-9935
  • Fax: 281-095-5126

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SAMSON UKAEGBU
Title or Position: OWNER
Credential:
Phone: 405-923-9935