MEDICARE: PROXIMUS HOME HEALTH SERVICES 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency	016074	TX

General Provider Information

NPI Number	:	1578998472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROXIMUS HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	2401 AVENUE J
Second Line	:	SUITE 215
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6230
Country	:	US
Telephone Number	:	817-633-9058
Fax Number	:	817-471-3269

Provider Business Practice Location Address
First Line	:	2401 AVENUE J
Second Line	:	SUITE 215
City	:	ARLINGTON
State	:	TX
Zip	:	76006-6230
Country	:	US
Telephone Number	:	817-633-9058
Fax Number	:	817-471-3269

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ETIENNE CLEMENT POUFONG
Credential	:	RN-BSN
Telephone Number	:	817-633-9058

Provider Enumeration Date	:	09/10/2013
Last Update Date	:	03/19/2014

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Directions to “PROXIMUS HOME HEALTH SERVICES INC ” Practice Location

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