MEDICARE: PRUDENT CHOICE HOMECARE SERVICE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053437145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRUDENT CHOICE HOMECARE SERVICE INC

Provider Business Mailing Address
First Line	:	2304 OAK LANE
Second Line	:	SUITE 221
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051
Country	:	US
Telephone Number	:	972-237-1000
Fax Number	:	972-237-1003

Provider Business Practice Location Address
First Line	:	2304 OAK LN
Second Line	:	SUITE 221
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-8812
Country	:	US
Telephone Number	:	972-237-1000
Fax Number	:	972-237-1003

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	OLAWOLE O SOYEBO
Credential	:
Telephone Number	:	972-237-1000

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	01/02/2012

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