Healthcare Provider Details

I. General information

NPI: 1003148313
Provider Name (Legal Business Name): MM HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 ROBIN RDG
SUNNYVALE TX
75182-3212
US

IV. Provider business mailing address

507 ROBIN RDG
SUNNYVALE TX
75182-3212
US

V. Phone/Fax

Practice location:
  • Phone: 972-285-1469
  • Fax: 972-285-1369
Mailing address:
  • Phone: 972-285-1469
  • Fax: 972-285-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number650287
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number650287
License Number StateTX

VIII. Authorized Official

Name: MRS. MINI T EASO
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 972-285-1469