=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053927863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELPING HANDS FOR GOLDEN AGERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2020
-----------------------------------------------------
Last Update Date | 04/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20135 CABLE BROOK LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-698-0610
-----------------------------------------------------
Fax | 281-578-9808
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20135 CABLE BROOK LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-698-0610
-----------------------------------------------------
Fax | 281-578-9808
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | IMELDA MAGDALENA LANDAVERDE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-698-0610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------