MEDICARE: ENVISION HOME HEALTH CARE, LLC

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	310400000X	Assisted Living Facility
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1285804211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	310 EAST I 30
Second Line	:	SUITE 314
City	:	GARLAND
State	:	TX
Zip	:	75043-8000
Country	:	US
Telephone Number	:	972-285-7286
Fax Number	:	972-285-7286

Provider Business Practice Location Address
First Line	:	310 EAST I 30
Second Line	:	SUITE 314
City	:	GARLAND
State	:	TX
Zip	:	75043-8000
Country	:	US
Telephone Number	:	972-285-7286
Fax Number	:	972-285-7286

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	MR. BOBBY SAMUEL KOSHY
Credential	:
Telephone Number	:	214-450-4306

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	02/12/2019

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