=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104967330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OVATIONS HEALTHCARE SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3261 ELIZABETH ANNE LN
-----------------------------------------------------
City | ROUND ROCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78664-5721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-771-6193
-----------------------------------------------------
Fax | 512-692-9142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1382
-----------------------------------------------------
City | PFLUGERVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78691-1382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-771-6193
-----------------------------------------------------
Fax | 512-692-9142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. OJ DOUGLAS IGWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 512-771-6193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010220
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------