The Prudent Healthcare Agency Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

THE PRUDENT HEALTHCARE AGENCY INC.

Practice address

2100 N Hwy 360
Suite207B
Grand Prairie, TX 75050-1011

Phone

(469) 999-0861

Fax

(469) 999-0860

NPI assigned

Apr 14, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Mondde Kelvin Iyamah, RN

Title

Administrator

Phone

(817) 663-3456

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Home health agency certification: CCN 747352

Legal name

THE PRUDENT HEALTHCARE AGENCY INC.

Doing business as

PRUDENT HEALTHCARE AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Feb 25, 2010

Last certification

Nov 20, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Dec 29, 2008 in TX

Enrollment address

2100 N State Highway 360
Ste 207a
Grand Prairie, TX 75050-1010

Listed as

Prudent Healthcare AgencyCCN 747352

Ownership

Proprietary

Certified

Feb 25, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1239667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1104069509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 N HWY 360 STE 207A",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750501010",
            "telephone_number": "469-999-0861",
            "fax_number": "469-999-0860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 N HWY 360",
            "address_2": "SUITE207B",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750501011",
            "telephone_number": "469-999-0861",
            "fax_number": "469-999-0860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PRUDENT HEALTHCARE AGENCY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-14",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "IYAMAH",
        "authorized_official_first_name": "MONDDE",
        "authorized_official_middle_name": "KELVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-663-3456",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2130064-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.