Princewill Healthcare Services Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PRINCEWILL HEALTHCARE SERVICES INC

Practice address

4100 Medical Pkwy Ste 250
Carrollton, TX 75007-1538

Phone

(972) 727-0784

Fax

(972) 727-0792

NPI assigned

Feb 19, 2009

Last updated

Aug 30, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelby MathewNPI 1285134650

Title

Administrator

Phone

(214) 886-8631

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386883064. Details of each certification follow.

• CCN 747490 Home health agency · Active · Details

Home health agency certification: CCN 747490

Legal name

PRINCEWILL HEALTHCARE SERVICES INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 21, 2010

Last certification

Feb 13, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Dec 9, 2008 in TX

Enrollment address

4100 Medical Pkwy
Ste 250
Carrollton, TX 75007

Listed as

Princewill Healthcare Services IncCCN 747490 · All quality measures

Ownership

Proprietary

Certified

Nov 21, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

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

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shelby Mathew, OTD

  • Occupational Therapist
  • Frisco, TX
  • NPI 1285134650
  NPD Authorized official
• Frank Azubuike Nwankwo, MD

  • Obstetrics & Gynecology Physician
  • Allen, TX
  • NPI 1780918185
  NPD (past)
• Sylvia Ogbogu-Nwankwo, NP

  • Family Nurse Practitioner
  • Allen, TX
  • NPI 1215543079
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Doris K Egyawan, NP

  • Family Nurse Practitioner
  • Mesquite, TX
  • NPI 1003380437

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1386883064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 MEDICAL PKWY STE 250",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750071538",
            "telephone_number": "972-727-0784",
            "fax_number": "972-727-0792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 MEDICAL PKWY STE 250",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750071538",
            "telephone_number": "972-727-0784",
            "fax_number": "972-727-0792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRINCEWILL HEALTHCARE SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-19",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "214-886-8631"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "282425201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251E00000X",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3747P1801X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.