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Organization
THE PRUDENT HEALTHCARE AGENCY INC.
Active
Organization
THE PRUDENT HEALTHCARE AGENCY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONDDE KELVIN IYAMAH RN (ADMINISTRATOR)
(817) 663-3456
Entity
Organization
Contact information
Practice address
2100 N HWY 360, SUITE207B, GRAND PRAIRIE, TX 75050-1011
(469) 999-0861
(469) 999-0860
Mailing address
2100 N HWY 360 STE 207A, GRAND PRAIRIE, TX 75050-1010
(469) 999-0861
(469) 999-0860
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2130064-01
—
TX
Enumeration date
04/14/2009
Last updated
12/04/2023
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