Provider Demographics
NPI:1629019401
Name:E S ALL STAR HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:E S ALL STAR HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMENIKE
Authorized Official - Middle Name:CHUKWUEMEKA
Authorized Official - Last Name:OSONDU
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:817-268-2282
Mailing Address - Street 1:405 AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5334
Mailing Address - Country:US
Mailing Address - Phone:817-268-2282
Mailing Address - Fax:817-268-2772
Practice Address - Street 1:405 AIRPORT FWY
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5358
Practice Address - Country:US
Practice Address - Phone:817-268-2282
Practice Address - Fax:817-268-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008259251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010041760Medicaid
TX0010041760Medicaid