MEDICARE: SANDRA HEALTH SERVICES

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1194082784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA HEALTH SERVICES

Provider Business Mailing Address
First Line	:	5451 INDEPENDENCE PKWY
Second Line	:	2506
City	:	PLANO
State	:	TX
Zip	:	75023-5465
Country	:	US
Telephone Number	:	469-443-2099
Fax Number	:	866-266-7890

Provider Business Practice Location Address
First Line	:	5451 INDEPENDENCE PKWY
Second Line	:	2506
City	:	PLANO
State	:	TX
Zip	:	75023-5465
Country	:	US
Telephone Number	:	469-443-2099
Fax Number	:	866-266-7890

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SANDRA EKATA EDOBOR
Credential	:
Telephone Number	:	469-443-2099

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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Directions to “SANDRA HEALTH SERVICES ” Practice Location

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