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General NPI Number Information
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NPI Number | 1023257003
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Entity Type | Organization
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Legal Business Name | BERTHA EZENAGU
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Dates
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Enumeration Date | 02/13/2009
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 9304 FOREST LN STE 248
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City | DALLAS
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State | TX
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Zip | 75243-6238
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Country | US
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Telephone | 214-341-2490
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Fax | 214-341-2492
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Provider Business Mailing Address
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Address Line | 9304 FOREST LN STE 248
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City | DALLAS
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State | TX
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Zip | 75243-6238
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Country | US
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Telephone | 214-341-2490
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Fax | 214-341-2492
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Authorized Official
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Title or Position | OWNER
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Name | BERTHA K EZENAGU
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Credential |
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Telephone | 214-341-2490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 009354
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License Number State | TX
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