=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184805780
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 1ST ABLECARE HEALTHCARE SERVICES, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2007
-----------------------------------------------------
Last Update Date | 01/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1475 HERITAGE PKWY SUITE 325
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-477-2529
-----------------------------------------------------
Fax | 817-477-3132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1475 HERITAGE PKWY SUITE 325
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76063-2735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-477-2529
-----------------------------------------------------
Fax | 817-477-3132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSES, CHIEF FINANCIAL
-----------------------------------------------------
Name | CAROLINE ODOEMENA
-----------------------------------------------------
Credential | R.N., D.O.N., C.E.O.
-----------------------------------------------------
Telephone | 817-477-2529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 009037
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 012031
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------