=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538142906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME TEAM HEALTHCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 MIDWAY RD STE#112
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-852-1505
-----------------------------------------------------
Fax | 972-385-1712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2201 MIDWAY RD STE#112
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75006-5068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-852-1505
-----------------------------------------------------
Fax | 972-385-1712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DIXIE WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-852-1505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 008279
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------