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NPI Code Detail

MEDICARE: ARK ABOVE HOME HEALTH AGENCY, LLC.

MEDICARE: ARK ABOVE HOME HEALTH AGENCY, 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
1251E00000XHome Health Agency012267TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1012267OTHERTXLICENSE

General Provider Information

NPI Number : 1710155023
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARK ABOVE HOME HEALTH AGENCY, LLC.
Provider Business Mailing Address
First Line : 5409 N JIM MILLER RD
Second Line : SUITE 203B
City : DALLAS
State : TX
Zip : 75227-1542
Country : US
Telephone Number : 214-320-7200
Fax Number : 214-320-7203
Provider Business Practice Location Address
First Line : 5409 N JIM MILLER RD
Second Line : SUITE 203B
City : DALLAS
State : TX
Zip : 75227-1542
Country : US
Telephone Number : 214-320-7200
Fax Number : 214-320-7203
Authorized Official
Title or Position : ADMINISTRATOR
Name : PEGGY RENEE CHANDLER
Credential :
Telephone Number : 214-320-7200
Provider Enumeration Date : 02/20/2008
Last Update Date : 02/17/2012

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