Healthcare Provider Details

I. General information

NPI: 1366624041
Provider Name (Legal Business Name): XTRA - CARE HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9894 BISSONNET ST 575
HOUSTON TX
77036-8239
US

IV. Provider business mailing address

9894 BISSONNET ST 575
HOUSTON TX
77036-8239
US

V. Phone/Fax

Practice location:
  • Phone: 713-270-1160
  • Fax: 713-270-1190
Mailing address:
  • Phone: 713-270-1160
  • Fax: 713-270-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number012316
License Number StateTX

VIII. Authorized Official

Name: MRS. ROSEMARY CHINYELUM UWAEZUOKE
Title or Position: ADMINISTRATOR/DIRECTOR OF NURSING
Credential:
Phone: 713-270-1160