MEDICARE: OAKSHADOWS HOME HEALTH CARE 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	009410	TX

General Provider Information

NPI Number	:	1386682573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKSHADOWS HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	410 MONMOUTH AVE
Second Line	:	SUITE 130
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 ALLENDALE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77017-5421
Country	:	US
Telephone Number	:	713-946-9393
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/DON
Name	:	JUDY ULLER
Credential	:	RN
Telephone Number	:	713-946-9393

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	12/01/2016

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