=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588045744
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIOCARE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2015
-----------------------------------------------------
Last Update Date | 06/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3820 EVESHAM DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-377-9129
-----------------------------------------------------
Fax | 214-377-9254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3820 EVESHAM DR
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75025-3818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-377-9129
-----------------------------------------------------
Fax | 214-377-9254
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RUKHE AGHOMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-604-4841
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------