Healthcare Provider Details

I. General information

NPI: 1417221441
Provider Name (Legal Business Name): PRIVATE HOME HEALTHCARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 N SAM HOUSTON PKWY E APT 338
HUMBLE TX
77396-4533
US

IV. Provider business mailing address

PO BOX 6963
HOUSTON TX
77265-6963
US

V. Phone/Fax

Practice location:
  • Phone: 281-253-4136
  • Fax: 281-458-0153
Mailing address:
  • Phone: 281-253-4136
  • Fax: 281-458-0153

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 Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: CARLA RENEE JACKSON
Title or Position: CEO
Credential:
Phone: 281-253-4136