=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972054724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENDURANCE HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2016
-----------------------------------------------------
Last Update Date | 10/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3605 WEST PIONEER PARKWAY SUITE A5-A6
-----------------------------------------------------
City | PANTEGO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-330-6330
-----------------------------------------------------
Fax | 682-330-6331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3605 WEST PIONEER PWKY SUITE A5-A6
-----------------------------------------------------
City | PANTEGO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-330-6330
-----------------------------------------------------
Fax | 682-330-6331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | ENDURANCE OHEMENG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 682-330-6330
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------