Healthcare Provider Details

I. General information

NPI: 1811432263
Provider Name (Legal Business Name): APOLLO HEALTHCARE AT WILLOWBROOK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13220 BRETON RIDGE STREET
HOUSTON TX
77070
US

IV. Provider business mailing address

6125 LUTHER LN # 309
DALLAS TX
75225-6202
US

V. Phone/Fax

Practice location:
  • Phone: 707-666-3490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ARCHANA THOTA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 832-912-4773