Organization Active NPI

Aetna Home Health Care and Management LLC

  • Home Health Agency
  • Dallas, TX
National Provider Identifier
1790360360
Registry record updated Jan 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
AETNA HOME HEALTH CARE AND MANAGEMENT LLC
Practice address
12989 Jupiter Rd Ste 103
Dallas, TX 75238-5248
Phone
(682) 381-9632
Fax
(682) 316-0058
NPI assigned
Mar 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2023

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

Authorized official

Name
Patience Akpandem
Title
Owner
Phone
(682) 381-9632

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Attendant Care ProviderGroup: 193200000X MULTI-SPECIALTY GROUP 3747A0650X
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X

Addresses

Primary practice location

12989 Jupiter Rd Ste 103
Dallas, TX 75238-5248

Mailing address

12989 Jupiter Rd Ste 103
Dallas, TX 75238-5248
Phone (682) 381-9632

Other identifiers 1

IdentifierTypeStateIssuer
423277901MedicaidTX

National Provider Directory

National Provider Directory

Locations

3250 W Market St
Ste 205
Fairlawn, OH 44333

NPI Registry JSON

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

{
    "created_epoch": "1615766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1790360360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12989 JUPITER RD STE 103",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752385248",
            "telephone_number": "682-381-9632",
            "fax_number": "682-316-0058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12989 JUPITER RD STE 103",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752385248",
            "telephone_number": "682-381-9632",
            "fax_number": "682-316-0058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AETNA HOME HEALTH CARE AND MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-15",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "AKPANDEM",
        "authorized_official_first_name": "PATIENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "682-381-9632"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3747A0650X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "423277901",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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.