NPIMap

Organization Active NPI

1St Prudential Health Care Services, Inc

  • Home Health Agency
  • Arlington, TX
National Provider Identifier
1780723924
Registry record updated Dec 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
011502 Issued in TX
Legal business name
1ST PRUDENTIAL HEALTH CARE SERVICES, INC
Practice address
700 Highlander Blvd
# 150
Arlington, TX 76015-4330
Phone
(682) 227-4630
Fax
(214) 946-7337
NPI assigned
Feb 5, 2007
Last updated
Dec 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2016

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

Authorized official

Name
Nne Ibum Elangwe, RN
Title
Administrator
Phone
(682) 227-4630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 011502 TX Primary

Addresses

Primary practice location

700 Highlander Blvd
# 150
Arlington, TX 76015-4330

Mailing address

700 Highlander Blvd
# 150
Arlington, TX 76015-4330
Phone (469) 726-2007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080428000364 TX Part A Provider - Home Health Agency 7810075199 Practice locations: Arlington, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780723924. Details of each certification follow.

Home health agency certification: CCN 679358

Legal name
1ST PRUDENTIAL HEALTH CARE SERVICES INC
Doing business as
1ST PRUDENTIAL HEALTH CARE SERVICES INC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 2, 2003
Last certification
Jun 4, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
4221 E Pleasant Forest St
Arlington, TX 76015-4504

Care Compare: Home health agency

Medicare Care Compare
Listed as
1St Prudential Health Care Services, Inc.CCN 679358 · All quality measures
Overall star rating
1.5 of 5
Ownership
Proprietary
Certified
Oct 2, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

700 Highlander Blvd
Ste 150
Arlington, TX 76015
Phone (469) 726-2007

2730 N Stemmons Fwy
Ste 505
Dallas, TX 75207
Phone (214) 634-3700

2730 N Stemmons Fwy
Ste 850
Dallas, TX 75207
Phone (469) 726-2007

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Joseph N Formusoh Individual Corporate DirectorBoard of Directors Dec 29, 2006
W-2 Managing EmployeeAlt. Admin., Alt. Supervising Nurse Feb 5, 2019
Nne I Elangwe Formusoh Individual 5% Or Greater Direct Ownership Interest Dec 29, 2006 100%
Corporate OfficerChief Financial Officer Dec 29, 2006
Corporate DirectorPresident Dec 29, 2006
Operational/Managerial ControlAdministrator, Supervising Nurse Dec 29, 2006

Practitioners & affiliated clinicians

Affiliated clinicians 7

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

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482192000000",
    "number": "1780723924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 HIGHLANDER BLVD",
            "address_2": "# 150",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760154330",
            "telephone_number": "469-726-2007",
            "fax_number": "469-726-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 HIGHLANDER BLVD",
            "address_2": "# 150",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760154330",
            "telephone_number": "682-227-4630",
            "fax_number": "214-946-7337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1ST PRUDENTIAL HEALTH CARE SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2016-12-20",
        "status": "A",
        "authorized_official_last_name": "ELANGWE",
        "authorized_official_first_name": "NNE",
        "authorized_official_middle_name": "IBUM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "682-227-4630",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "011502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, TX

Sources for this page

Verify at the official NPI Registry.