=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043536089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOVING HANDS PROVIDER SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2010
-----------------------------------------------------
Last Update Date | 11/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 DEERHURST LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77088-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-560-4823
-----------------------------------------------------
Fax | 832-664-9405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1915 DEERHURST LN
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77088-3318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-560-4823
-----------------------------------------------------
Fax | 832-664-9405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YOLANDA POTTS MITCHELL-WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-560-4823
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------