Healthcare Provider Details

I. General information

NPI: 1679945059
Provider Name (Legal Business Name): RICELAND HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 I-10 FRONTAGE ROAD SUITE 100
BEAUMONT TX
77707
US

IV. Provider business mailing address

85 I-10 FRONTAGE ROAD SUITE 100
BEAUMONT TX
77707
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-7744
  • Fax: 409-385-7723
Mailing address:
  • Phone: 409-385-7744
  • Fax: 409-385-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number017407
License Number StateTX

VIII. Authorized Official

Name: M. TAHIR JAVED
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 409-840-9601