MEDICARE: MEDIEQUIP PATIENT & HOME SERVICES

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1114392248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIEQUIP PATIENT & HOME SERVICES

Provider Business Mailing Address
First Line	:	3418 HIGHWAY 6 S
Second Line	:	B217
City	:	HOUSTON
State	:	TX
Zip	:	77082-4206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 HIGHWAY 6 S
Second Line	:	B217
City	:	HOUSTON
State	:	TX
Zip	:	77082-4206
Country	:	US
Telephone Number	:	713-344-0855
Fax Number	:

Authorized Official
Title or Position	:	LDE/OWNER
Name	:	ANGELA Y JOHNSON
Credential	:
Telephone Number	:	713-344-0855

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	12/01/2015

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Directions to “MEDIEQUIP PATIENT & HOME SERVICES ” Practice Location

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