Healthcare Provider Details

I. General information

NPI: 1912543018
Provider Name (Legal Business Name): ANGELFAITH PEDIATRIC HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2019
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17703 CYPRESS HILL DR
ROSHARON TX
77583-8266
US

IV. Provider business mailing address

17703 CYPRESS HILL DR
ROSHARON TX
77583-8266
US

V. Phone/Fax

Practice location:
  • Phone: 281-369-0690
  • Fax: 833-877-1558
Mailing address:
  • Phone: 281-369-0690
  • Fax: 833-877-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: DONSHANEICE MECHELLE BROWN
Title or Position: ADMINISTRATOR/MANAGING MEMBER
Credential:
Phone: 832-800-5729