MEDICARE: INDEPENDENT HEALTHCARE CONNECTIONS 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

General Provider Information

NPI Number	:	1497138812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT HEALTHCARE CONNECTIONS LLC

Provider Business Mailing Address
First Line	:	11223 CARRIAGE LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-5009
Country	:	US
Telephone Number	:	832-603-7489
Fax Number	:

Provider Business Practice Location Address
First Line	:	11800 JONES RD
Second Line	:	SUITE D
City	:	HOUSTON
State	:	TX
Zip	:	77070-5487
Country	:	US
Telephone Number	:	832-603-7489
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MITIKA STANFORD
Credential	:
Telephone Number	:	832-603-7489

Provider Enumeration Date	:	07/02/2015
Last Update Date	:	07/02/2015

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