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General NPI Number Information
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NPI Number | 1063593226
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Entity Type | Organization
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Legal Business Name | SSQ HOME HEALTH CARE,INC
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 4445 CORNER BROOK LANE
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City | FORT WORTH
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State | TX
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Zip | 76123
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Country | US
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Telephone | 817-333-4499
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Fax | 817-297-8936
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Provider Business Mailing Address
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Address Line | 4445 CORNER BROOK LANE
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City | FORT WORTH
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State | TX
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Zip | 76123
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Country | US
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Telephone | 817-333-4499
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Fax | 817-297-8936
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SANDRA WOODBERRY
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Credential | RN
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Telephone | 817-333-4499
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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 | 011055
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License Number State | TX
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