Provider Demographics
NPI:1871915975
Name:CVS HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:CVS HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTHOSH
Authorized Official - Middle Name:V
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-224-6100
Mailing Address - Street 1:3939 US HIGHWAY 80 E STE 254
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3371
Mailing Address - Country:US
Mailing Address - Phone:972-224-6100
Mailing Address - Fax:972-224-6101
Practice Address - Street 1:3939 US HIGHWAY 80 E STE 254
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3371
Practice Address - Country:US
Practice Address - Phone:972-224-6100
Practice Address - Fax:972-224-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012255251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2082869Medicaid
TX747072Medicare PIN