Provider Demographics
NPI:1902346752
Name:SAS HOME HEALTH HOSPICE SERVICES
Entity Type:Organization
Organization Name:SAS HOME HEALTH HOSPICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AZUBUIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-698-0404
Mailing Address - Street 1:4593 MOUNTAIN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2903
Mailing Address - Country:US
Mailing Address - Phone:972-805-6674
Mailing Address - Fax:972-698-0844
Practice Address - Street 1:3939 US HIGHWAY 80 E STE 305
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-8110
Practice Address - Country:US
Practice Address - Phone:972-698-0404
Practice Address - Fax:972-698-0844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAS HOME HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012652251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001021001Medicaid
TX001021001Medicaid