HOMAGE HEALTHCARE SERVICES, INC - NPI NUMBER 1275822009

Summary

Provider Name: HOMAGE HEALTHCARE SERVICES, INC

NPI Number: 1275822009

Clasification: Home Health (251E00000X)

Address:
3008 NADAR
GRAND PRAIRIE, TX
ZIP 75054

Phone Number: (817) 323-7630



Detailed Information

HOMAGE HEALTHCARE SERVICES, INC is a home health in Grand Prairie, TX. The provider is a public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety. The assigned NPI number for this provider is 1275822009 and is registered as an organization entity type.

The provider's business address is:

3008 NADAR
GRAND PRAIRIE, TX
ZIP 75054
Phone: (817) 323-7630
Fax: (682) 222-7574

The provider's authorized official is Donatus E Benson .
The authorized official title is Director and has the following contact phone number (817) 323-7630.

The enumeration date for this NPI number is 4/1/2011 and was last updated on 4/1/2011.





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251E00000X Home Health Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1275822009 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name HOMAGE HEALTHCARE SERVICES, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 3008 NADAR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name GRAND PRAIRIE The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name TX The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 75054 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 8173237630 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 6822227574 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 4/1/2011 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 4/1/2011 The date that a record was last updated or changed.
14 Authorized Official Last Name BENSON The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name DONATUS The first name of the authorized official.
16 Authorized Official Middle Name E The middle name of the authorized official.
17 Authorized Official Title or Position DIRECTOR The title or position of the authorized official.
18 Authorized Official Telephone Number 8173237630 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 251E00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Organization Subpart N
22 Authorized Official Name Prefix Text MR.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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