Healthcare Provider Details

I. General information

NPI: 1073939872
Provider Name (Legal Business Name): WYKEITA WHITE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 W LITTLE YORK RD
HOUSTON TX
77076-1303
US

IV. Provider business mailing address

PO BOX 3342
SPRING TX
77383-3342
US

V. Phone/Fax

Practice location:
  • Phone: 832-656-1073
  • Fax: 832-288-5695
Mailing address:
  • Phone: 832-656-1073
  • Fax: 832-288-5695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number015093
License Number StateTX

VIII. Authorized Official

Name: WYKEITA WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 832-656-1073