Healthcare Provider Details

I. General information

NPI: 1710453204
Provider Name (Legal Business Name): MVP PEDIATRIC HOME HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 01/16/2024
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 HOLCOMB CIR
TYLER TX
75703-0821
US

IV. Provider business mailing address

9952 FM 346 E
WHITEHOUSE TX
75791-5730
US

V. Phone/Fax

Practice location:
  • Phone: 903-508-4848
  • Fax: 903-508-4849
Mailing address:
  • Phone: 903-508-4848
  • Fax: 903-508-4849

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 TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE LEACH
Title or Position: ADMINISTRATOR, CFO, OWNER
Credential:
Phone: 903-508-4848