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General NPI Number Information
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NPI Number | 1033620448
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Entity Type | Organization
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Legal Business Name | SHOSHANA HOME CARE LLC
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 920 FM 1092 RD STE 215
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City | STAFFORD
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State | TX
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Zip | 77477-5975
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Country | US
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Telephone | 281-969-8576
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Fax |
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Provider Business Mailing Address
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Address Line | 920 FM 1092 RD STE 215
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City | STAFFORD
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State | TX
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Zip | 77477-5975
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Country | US
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Telephone | 281-969-8576
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | ROBBY MATHEW
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Credential |
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Telephone | 832-506-1024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 018212
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License Number State | TX
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