=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306941950
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRADITIONAL HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4545 FULLER DR STE 330
-----------------------------------------------------
City | IRVING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75038-6557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-871-7500
-----------------------------------------------------
Fax | 972-871-7504
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 35TH ST STE 4-5B516
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11232-2021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-748-5908
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. DAVID ALBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-748-5908
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 013018
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------