MEDICARE: NORTHEAST NSG. SVCS. PHC HMO INC

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	007149	TX

General Provider Information

NPI Number	:	1508911629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST NSG. SVCS. PHC HMO INC

Provider Business Mailing Address
First Line	:	PO BOX 16236
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77222-6236
Country	:	US
Telephone Number	:	713-694-2742
Fax Number	:	713-862-4010

Provider Business Practice Location Address
First Line	:	6643 W MONTGOMERY RD
Second Line	:	NA
City	:	HOUSTON
State	:	TX
Zip	:	77091-3103
Country	:	US
Telephone Number	:	713-964-2742
Fax Number	:	713-862-4010

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	PROF. VIVIAN D. GARNER
Credential	:	R.N.
Telephone Number	:	713-694-2742

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	09/06/2023

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