MEDICARE: HACINTH HEALTHCARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	462906	TX

General Provider Information

NPI Number	:	1114203197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HACINTH HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	19943 CYPRESSWOOD CRK
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-3092
Country	:	US
Telephone Number	:	281-528-7881
Fax Number	:	281-528-7881

Provider Business Practice Location Address
First Line	:	19943 CYPRESSWOOD CRK
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-3092
Country	:	US
Telephone Number	:	281-528-7881
Fax Number	:	281-528-7881

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. NEILA HACINTH LEWIS
Credential	:	RN
Telephone Number	:	281-528-7881

Provider Enumeration Date	:	10/23/2011
Last Update Date	:	10/23/2011

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