Organization
ANI HOME HEALTH AGENCY LTD CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ORITSEBEMIGHO EDEGBELE (ADMINISTRATOR)
(972) 228-4100
Entity
Organization
Contact information
Practice address
215A EXECUTIVE WAY, # 120, DESOTO, TX 75115-8300
(972) 228-4100
(972) 228-4128
Mailing address
1510 N HAMPTON RD, SUITE 360, DESOTO, TX 75115-8300
(972) 228-4100
(972) 228-4128
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
007896
TX
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001021318
—
TX
01
—
01365146
WELLPOINT AMERIGROUP
TX
01
—
1295735439
AETNA BETTER HEALTH OF TEXAS
TX
01
—
QMP000003835502
MOLINA HEALTHCARE OF TEXAS
TX
01
—
S50019732
SUPERIOR HEALTHPLAN TEXAS
TX
Enumeration date
07/29/2005
Last updated
06/13/2024
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