Healthcare Provider Details

I. General information

NPI: 1124802905
Provider Name (Legal Business Name): NEW WAVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3422 HARVEST MEADOW LN
ROSENBERG TX
77471-1748
US

IV. Provider business mailing address

3422 HARVEST MEADOW LN
ROSENBERG TX
77471-1748
US

V. Phone/Fax

Practice location:
  • Phone: 215-582-9779
  • Fax:
Mailing address:
  • Phone: 215-582-9779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE A MACK
Title or Position: ALT ADMINISTRATOR/MANAGING MEMBER
Credential:
Phone: 215-582-9779