Provider Demographics
NPI:1801160486
Name:BOTAG HOME HEALTHCARE SERVICES INC.
Entity type:Organization
Organization Name:BOTAG HOME HEALTHCARE SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BAYO
Authorized Official - Middle Name:N
Authorized Official - Last Name:OMOTARA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:214-442-3081
Mailing Address - Street 1:3939 US HIGHWAY 80 E
Mailing Address - Street 2:SUITE # 143 K
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3359
Mailing Address - Country:US
Mailing Address - Phone:214-442-3081
Mailing Address - Fax:
Practice Address - Street 1:3939 US HIGHWAY 80 E
Practice Address - Street 2:SUITE # 143 K
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3359
Practice Address - Country:US
Practice Address - Phone:214-442-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOTAG HOME HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-29
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health