Healthcare Provider Details

I. General information

NPI: 1508688177
Provider Name (Legal Business Name): ENTRUSTED PEDIATRIC HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 BOWHILL DR
AUSTIN TX
78731-3806
US

IV. Provider business mailing address

3921 STECK AVE STE A120
AUSTIN TX
78759-8669
US

V. Phone/Fax

Practice location:
  • Phone: 817-455-7476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS NORWOOD
Title or Position: CEO
Credential:
Phone: 817-455-7476