=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952371239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COOK CHILDRENS HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2006
-----------------------------------------------------
Last Update Date | 08/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 W VICKERY BLVD
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76104-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-885-6294
-----------------------------------------------------
Fax | 682-885-2499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 99283
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76199-1383
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-885-6294
-----------------------------------------------------
Fax | 682-885-5606
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL R SIMMONS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-885-2409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 20616
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------