1St Prudential Health Care Services, Inc
Organization Active NPI Home Health Agency · Arlington, TX
NPI 1780723924 · NPPES record last updated Dec 20, 2016
Key facts
- NPI
- 1780723924
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 011502 (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
- Organization subpart
- No
Authorized official
- Name
- Nne Ibum Elangwe, RN
- Title
- Administrator
- Phone
- (682) 227-4630
Affiliated clinicians 7
-
William P. Coleman, M.D.
-
Bhaviniben S Patel, M.D.
Medicare Care Compare: Home health agency
- Listed as
- 1St Prudential Health Care Services, Inc.
- Overall star rating
- ★★☆☆☆ 1.5 of 5
- Ownership
- Proprietary
- Certified
- Oct 2, 2003
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
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
- Corporation · Proprietary
- Enrollment address
- 4221 E Pleasant Forest St
Arlington, TX 76015-4504
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Joseph N Formusoh |
Corporate Director |
Dec 29, 2006 | |
| W-2 Managing Employee |
Feb 5, 2019 | ||
| Nne I Elangwe Formusoh |
5% Or Greater Direct Ownership Interest | Dec 29, 2006 | 100% |
| Corporate Officer |
Dec 29, 2006 | ||
| Corporate Director |
Dec 29, 2006 | ||
| Operational/Managerial Control |
Dec 29, 2006 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080428000364 | TX | Part a Provider - Home Health Agency | 7810075199 | Practice locations: Arlington, TX |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 011502 | TX | Yes |
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
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All providers in Arlington, TX · Home Health Agency in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.