Healthcare Provider Details

I. General information

NPI: 1831266287
Provider Name (Legal Business Name): HEALTHLINE REHAB & MEDICAL CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 NORTH FWY STE 204 #106
HOUSTON TX
77022-2920
US

IV. Provider business mailing address

4615 NORTH FWY STE 204 #204
HOUSTON TX
77022-2920
US

V. Phone/Fax

Practice location:
  • Phone: 713-694-0051
  • Fax: 713-694-4711
Mailing address:
  • Phone: 713-694-0051
  • Fax: 713-694-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0062557
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007865
License Number StateTX

VIII. Authorized Official

Name: MR. HYACINTH MADUEKE CHIEDU
Title or Position: ADMINISTRATOR
Credential: CRTT
Phone: 713-694-0051