St Nicholas Provider Services Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

010407 Issued in TX

Legal business name

ST NICHOLAS PROVIDER SERVICES INC

Practice address

7008 Lake Jackson Dr
Arlington, TX 76002-4054

Phone

(817) 468-9006

Fax

(817) 468-9006

NPI assigned

Jul 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Olufesola M Fasakin, RN

Title

Administrator

Phone

(817) 468-9006

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1013934751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7008 LAKE JACKSON DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760024054",
            "telephone_number": "817-468-9006",
            "fax_number": "817-468-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7008 LAKE JACKSON DR",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760024054",
            "telephone_number": "817-468-9006",
            "fax_number": "817-468-9006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST NICHOLAS PROVIDER SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "FASAKIN",
        "authorized_official_first_name": "OLUFESOLA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-468-9006",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "010407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE HOME HEALTH LICENSE",
            "identifier": "010407",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205352201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Arlington, TX
• Providers in Arlington, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.