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General NPI Number Information
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NPI Number | 1205211216
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Entity Type | Organization
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Legal Business Name | INTRA HOME HEALTH CARE AGENCY LLC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 11/25/2015
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Provider Practice Location Address
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Address Line | 10101 FONDREN RD 255
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City | HOUSTON
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State | TX
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Zip | 77096-4564
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Country | US
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Telephone | 281-899-9338
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Fax | 281-746-1259
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Provider Business Mailing Address
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Address Line | 10101 FONDREN RD 255
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City | HOUSTON
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State | TX
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Zip | 77096-4564
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Country | US
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Telephone | 346-571-0963
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Fax | 346-571-0148
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JEAN M KELLEY
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Credential |
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Telephone | 346-571-0963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 017115
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License Number State | TX
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