Healthcare Provider Details

I. General information

NPI: 1619051083
Provider Name (Legal Business Name): CHILDREN'S HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14950 HEATHROW FOREST PKWY SUITE 250
HOUSTON TX
77032
US

IV. Provider business mailing address

14950 HEATHROW FOREST PKWY SUITE 250
HOUSTON TX
77032
US

V. Phone/Fax

Practice location:
  • Phone: 281-921-2301
  • Fax: 281-921-2305
Mailing address:
  • Phone: 281-921-2301
  • Fax: 281-921-2305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number010758
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number010758
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CORY CASPERSON
Title or Position: VP FINANCIAL MGMT
Credential:
Phone: 281-921-2301