MEDICARE: FIRST PHYSICIANS HOME HEALTH SERVICE 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1518521558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST PHYSICIANS HOME HEALTH SERVICE LLC

Provider Business Mailing Address
First Line	:	600 LEGACY DR APT 616
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-2213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 LEGACY DR APT 616
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75023-2213
Country	:	US
Telephone Number	:	214-929-0469
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NINA JACKSON
Credential	:
Telephone Number	:	214-929-0469

Provider Enumeration Date	:	04/25/2019
Last Update Date	:	07/29/2020

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