Healthcare Provider Details

I. General information

NPI: 1518570878
Provider Name (Legal Business Name): MACKS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/02/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TEMPLE LN
NEW WAVERLY TX
77358
US

IV. Provider business mailing address

539 W COMMERCE ST STE 4959
DALLAS TX
75208-1953
US

V. Phone/Fax

Practice location:
  • Phone: 312-481-4695
  • Fax:
Mailing address:
  • Phone: 312-481-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MCBETH
Title or Position: MANAGIN MBR
Credential:
Phone: 312-481-4695