=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063599264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARVELOUS CHOICE HOME HEALTH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 09/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8035 E RL THRTN FWY STE 452
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-324-9099
-----------------------------------------------------
Fax | 214-324-3090
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8035 E RL THRTN FWY STE 452
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-324-9099
-----------------------------------------------------
Fax | 214-324-3090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR DIRECTOR OF NURSE
-----------------------------------------------------
Name | CHRISTIANA I LEKWUWA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-324-9099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011933
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011933
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------