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General NPI Number Information
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NPI Number | 1326372582
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Entity Type | Organization
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Legal Business Name | CROWNDESEA HOME HEALTH CARE INC
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 12/23/2012
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Provider Practice Location Address
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Address Line | 1322 SAN MIGUEL DR
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City | DUNCANVILLE
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State | TX
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Zip | 75137-3073
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Country | US
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Telephone | 972-298-7030
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Fax | 972-298-7180
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Provider Business Mailing Address
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Address Line | 1322 SAN MIGUEL DR
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City | DUNCANVILLE
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State | TX
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Zip | 75137-3073
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Country | US
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Telephone | 972-298-7030
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Fax | 972-298-7180
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SAMSON ADEWOLE ADEDOKUN
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Credential |
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Telephone | 972-298-7030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 014245
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License Number State | TX
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