Healthcare Provider Details

I. General information

NPI: 1649360611
Provider Name (Legal Business Name): CRISKEL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 ABRAMS RD STE 105
RICHARDSON TX
75081-5581
US

IV. Provider business mailing address

1221 ABRAMS RD STE 105
RICHARDSON TX
75081-5581
US

V. Phone/Fax

Practice location:
  • Phone: 214-660-9382
  • Fax: 214-660-3727
Mailing address:
  • Phone: 214-660-9382
  • Fax: 214-660-3727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number010036
License Number StateTX

VIII. Authorized Official

Name: MRS. KELECHI N OGBUEHI
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 214-660-9382