=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871029850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACOM HEALTHCARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2017
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5900 S LAKE FOREST DR STE 300
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-595-7233
-----------------------------------------------------
Fax | 972-984-7896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5900 S LAKE FOREST DR STE 300
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-595-7233
-----------------------------------------------------
Fax | 972-984-7896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF NURSING
-----------------------------------------------------
Name | MRS. ADEBUKOLA OBASANYA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 972-302-4683
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------