Healthcare Provider Details

I. General information

NPI: 1124588694
Provider Name (Legal Business Name): RESTORE HOME HEALTH OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 SOUTHWEST FWY
HOUSTON TX
77074-1519
US

IV. Provider business mailing address

9100 SOUTHWEST FWY
HOUSTON TX
77074-1519
US

V. Phone/Fax

Practice location:
  • Phone: 832-359-6672
  • Fax:
Mailing address:
  • Phone: 832-359-6672
  • 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: HANA JOB
Title or Position: OWNER
Credential: MA
Phone: 832-359-6672