Healthcare Provider Details

I. General information

NPI: 1700136132
Provider Name (Legal Business Name): APOLLO HEALTHCARE AT BAY AREA, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 EAST SAM HOUSTON PARKWAY SOUTH
PASADENA TX
77505
US

IV. Provider business mailing address

6125 LUTHER LANE PMB 309
DALLAS TX
75225
US

V. Phone/Fax

Practice location:
  • Phone: 707-666-3490
  • Fax:
Mailing address:
  • Phone: 707-666-3490
  • Fax: 972-474-9020

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:
Phone: 707-666-3490