| Organization Name: | IMMACULATE HOME CARE SERVICES |
| NPI Number: | 1003076340 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH OLUFEMI OGUNGBIRE (OWNER) |
| Mailing Address: | 2304 Oak Ln Suite 13 Grand Prairie |
| State: | TX US |
| Postal Code: | 750518812 |
| Phone Number: | 9722643000 |
| Fax Number: | 9722645700 |
| NPI Enumeration Date: | 06/10/2008 |
| NPI Last Update Date: | 06/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |