MEDICARE: HOUSTON ULTIMATE HEALTHCARE 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

General Provider Information

NPI Number	:	1841826989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON ULTIMATE HEALTHCARE INC.

Provider Business Mailing Address
First Line	:	3418 HIGHWAY 6 S STE 306
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4206
Country	:	US
Telephone Number	:	713-307-2599
Fax Number	:

Provider Business Practice Location Address
First Line	:	3418 HIGHWAY 6 S STE 306
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-4206
Country	:	US
Telephone Number	:	713-307-2599
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ATIBA THOMAS
Credential	:
Telephone Number	:	713-307-2599

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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