MEDICARE: PASSION 05 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	251E00000X	Home Health Agency		TX

General Provider Information

NPI Number	:	1588840599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PASSION 05 HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	1140 EMPIRE CENTRAL DR STE 630
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4393
Country	:	US
Telephone Number	:	214-253-2654
Fax Number	:	214-253-2655

Provider Business Practice Location Address
First Line	:	1140 EMPIRE CENTRAL DR STE 630
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4393
Country	:	US
Telephone Number	:	214-253-2654
Fax Number	:	214-253-2655

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ALERO TINA OKUNDIA
Credential	:	RN
Telephone Number	:	214-253-2654

Provider Enumeration Date	:	01/21/2008
Last Update Date	:	04/05/2022

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