Basic Information
| Provider Information | |||||||||
| NPI: | 1730283227 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THERACARE HOME HEALTH LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17047 EL CAMINO REAL STE 110 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770582615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149086353 | ||||||||
| FaxNumber: | 9402411246 | ||||||||
| Practice Location | |||||||||
| Address1: | 17047 EL CAMINO REAL | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814884663 | ||||||||
| FaxNumber: | 2814884662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 12/03/2007 | ||||||||
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| AuthorizedOfficialLastName: | NEVILLE | ||||||||
| AuthorizedOfficialFirstName: | ROBBIE | ||||||||
| AuthorizedOfficialMiddleName: | DALE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2149086353 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 009909 | TX | Y | Agencies | Home Health |
No ID Information.