=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609031103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVICARE HOME HEALTH SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2008
-----------------------------------------------------
Last Update Date | 05/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4506 VAUGHAN DR
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-475-3358
-----------------------------------------------------
Fax | 972-475-3385
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4506 VAUGHAN DR
-----------------------------------------------------
City | ROWLETT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75088-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-475-3358
-----------------------------------------------------
Fax | 972-475-3385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. OKEY FESTUS NWAGBARA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-708-0653
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------