Healthcare Provider Details

I. General information

NPI: 1992371744
Provider Name (Legal Business Name): OLMOS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16640 HOLLY TRAIL DR
HOUSTON TX
77058-2211
US

IV. Provider business mailing address

16640 HOLLY TRAIL DR
HOUSTON TX
77058-2211
US

V. Phone/Fax

Practice location:
  • Phone: 832-274-0866
  • Fax:
Mailing address:
  • Phone: 832-274-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JAVIER ENRIQUE OLMOS SR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 281-703-9147