=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205162914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICE HOME HEALTH AGENCY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2009
-----------------------------------------------------
Last Update Date | 10/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9304 FOREST LANE SUITE 116
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-681-6360
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9304 FOREST LANE SUITE 116
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. BIBIAN CHIKE-EGBOH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-681-6360
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 567449
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------