=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598220477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING POOL HOME HEALTHCARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2019
-----------------------------------------------------
Last Update Date | 07/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9696 SKILLMAN ST STE 200A
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-8264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-440-7151
-----------------------------------------------------
Fax | 844-837-1906
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9696 SKILLMAN ST STE 200A2-3
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75243-8264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-440-7151
-----------------------------------------------------
Fax | 844-837-1906
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATION
-----------------------------------------------------
Name | REGINA EDAMWEN IYAWE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-440-7151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------