Healthcare Provider Details

I. General information

NPI: 1962910109
Provider Name (Legal Business Name): DECCAN HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 WOODWAY DR APT 123
HOUSTON TX
77056-1736
US

IV. Provider business mailing address

5010 WOODWAY DR APT 123
HOUSTON TX
77056-1736
US

V. Phone/Fax

Practice location:
  • Phone: 702-445-1354
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED AHMED
Title or Position: MANAGER
Credential:
Phone: 702-445-1354