St Nicholas Provider Services INC
Home Health in Arlington, TX. Organization (NPI-2).
NPI number1013934751
StatusActive
Last updated in NPPESJul 19, 2010
Details
- NPI
- 1013934751
- Entity type
- Organization (NPI-2)
- Legal business name
- St Nicholas Provider Services INC
- Organization subpart
- No
- Enumeration date
- Jul 17, 2006
- Last updated
- Jul 19, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251E00000X | Home Health | 010407 | TX | Yes |
Practice location
7008 Lake Jackson DrArlington, TX 76002-4054
Phone 817-468-9006 · Fax 817-468-9006
Mailing address
7008 Lake Jackson DrArlington, TX 76002-4054
Phone 817-468-9006 · Fax 817-468-9006
Authorized official
Olufesola M Fasakin
Administrator
8174689006
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