=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861563173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR HOMECARE,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2006
-----------------------------------------------------
Last Update Date | 10/18/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2636 WALNUT HILL LN STE 201
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75229-4554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-350-4033
-----------------------------------------------------
Fax | 214-350-4689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2636 WALNUT HILL LN STE 201
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75229-4554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-350-4033
-----------------------------------------------------
Fax | 214-350-4689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. RICHARD NANA NKWANWO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-350-4033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 011578
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------