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NPI Code Detail

MEDICARE: FARMINGTON PLACE HEALTHCARE SERVICES

MEDICARE: FARMINGTON PLACE HEALTHCARE 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
1251E00000XHome Health Agency9059TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
19059OTHERTXTEXAS HCSSA LICENSE #

General Provider Information

NPI Number : 1255589834
Entity Type Code : Organization
Provider Name (Legal Business Name) : FARMINGTON PLACE HEALTHCARE SERVICES
Provider Business Mailing Address
First Line : 11325 PEGASUS ST S-142
Second Line :
City : DALLAS
State : TX
Zip : 75238-5239
Country : US
Telephone Number : 214-221-0020
Fax Number :
Provider Business Practice Location Address
First Line : 11325 PEGASUS ST # S-142
Second Line :
City : DALLAS
State : TX
Zip : 75238-5239
Country : US
Telephone Number : 214-221-0020
Fax Number :
Authorized Official
Title or Position : CEO/ADMINISTRATOR
Name : MR. KEHINDE OLUGBOLAHAN OGUNDIPE
Credential :
Telephone Number : 214-221-0020
Provider Enumeration Date : 09/08/2008
Last Update Date : 09/08/2008

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Directions to “FARMINGTON PLACE HEALTHCARE SERVICES ” Practice Location

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