Provider Demographics
NPI:1053155747
Name:ESSENTIAL HEALTH CARE SYSTEMS PROFESSIONAL LIMITED LIABILITY COM
Entity type:Organization
Organization Name:ESSENTIAL HEALTH CARE SYSTEMS PROFESSIONAL LIMITED LIABILITY COM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETHELBERT
Authorized Official - Middle Name:ONUEFI
Authorized Official - Last Name:ODO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-556-1467
Mailing Address - Street 1:611 PONDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6219
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:606 ORIOLE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3500
Practice Address - Country:US
Practice Address - Phone:469-556-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-19
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty