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General NPI Number Information
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NPI Number | 1134466378
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Entity Type | Organization
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Legal Business Name | IN HOME SERVICES OF SOUTHEAST TEXAS
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Dates
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Enumeration Date | 01/08/2013
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Last Update Date | 01/08/2013
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Provider Practice Location Address
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Address Line | 4973 CARLTON ST
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City | ORANGE
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State | TX
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Zip | 77632-5654
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Country | US
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Telephone | 409-791-6894
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2124
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City | BUNA
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State | TX
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Zip | 77612-2124
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Country | US
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Telephone | 409-651-0991
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER FORD
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Credential | BEHAVIOR CONSULTANT
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Telephone | 409-791-6894
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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