Healthcare Provider Details

I. General information

NPI: 1578031381
Provider Name (Legal Business Name): CLASSIC HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 02/20/2026
Certification Date: 02/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 RICHARDSON DR STE 205B
RICHARDSON TX
75080-4677
US

IV. Provider business mailing address

1202 RICHARDSON DR STE 205
RICHARDSON TX
75080-4677
US

V. Phone/Fax

Practice location:
  • Phone: 972-908-0135
  • Fax: 972-332-4109
Mailing address:
  • Phone: 972-908-0135
  • Fax: 972-332-4109

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DICKSON ALAO
Title or Position: ADMINISTRATOR
Credential:
Phone: 972-908-0135