Provider Demographics
NPI:1295735439
Name:ANI HOME HEALTH AGENCY LTD CO
Entity type:Organization
Organization Name:ANI HOME HEALTH AGENCY LTD CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORITSEBEMIGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:EDEGBELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-228-4100
Mailing Address - Street 1:1510 N HAMPTON RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8300
Mailing Address - Country:US
Mailing Address - Phone:972-228-4100
Mailing Address - Fax:972-228-4128
Practice Address - Street 1:215A EXECUTIVE WAY
Practice Address - Street 2:# 120
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8300
Practice Address - Country:US
Practice Address - Phone:972-228-4100
Practice Address - Fax:972-228-4128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX007896251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01365146OtherWELLPOINT AMERIGROUP
TX1295735439OtherAETNA BETTER HEALTH OF TEXAS
TX001021318Medicaid
TX1295735439OtherCOOK CHILDREN'S HEALTH PLAN
TXS50019732OtherSUPERIOR HEALTHPLAN TEXAS
TXQMP000003835502OtherMOLINA HEALTHCARE OF TEXAS