Provider Demographics
NPI:1922280221
Name:CANNULIF HEALTHCARE SERVICES, INC
Entity type:Organization
Organization Name:CANNULIF HEALTHCARE SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:SOOK
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-923-2009
Mailing Address - Street 1:2665 VILLA CREEK DRIVE
Mailing Address - Street 2:SUITE NO #A125
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7309
Mailing Address - Country:US
Mailing Address - Phone:214-503-8941
Mailing Address - Fax:214-503-8955
Practice Address - Street 1:2665 VILLA CREEK DRIVE
Practice Address - Street 2:SUITE NO #A125
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7309
Practice Address - Country:US
Practice Address - Phone:214-503-8941
Practice Address - Fax:214-503-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1922280221Medicaid