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General NPI Number Information
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NPI Number | 1285981563
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Entity Type | Organization
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Legal Business Name | DOMAIN HOME CARE SERVICES
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 9800 BRAEBURN GLEN BLVD APT 28
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City | HOUSTON
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State | TX
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Zip | 77074-2313
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Country | US
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Telephone | 832-267-6192
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Fax |
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Provider Business Mailing Address
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Address Line | 9800 BRAEBURN GLEN BLVD APT 28
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City | HOUSTON
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State | TX
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Zip | 77074-2313
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Country | US
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Telephone | 832-267-6192
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ANITA CHIGBO GATES
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Credential | MD
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Telephone | 832-267-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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