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General NPI Number Information
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NPI Number | 1316001191
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Entity Type | Organization
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Legal Business Name | EDICARE PROFESSIONAL HEALTHCARE SERVICES, INC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 2000 S DAIRY ASHFORD ST SUITE #305
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City | HOUSTON
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State | TX
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Zip | 77077-5700
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Country | US
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Telephone | 281-568-4573
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Fax | 281-879-8411
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Provider Business Mailing Address
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Address Line | 2000 S DAIRY ASHFORD ST SUITE #305
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City | HOUSTON
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State | TX
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Zip | 77077-5700
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Country | US
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Telephone | 281-568-4573
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Fax | 281-879-8411
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Authorized Official
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Title or Position | ALT ADMINISTRATOR
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Name | EDOSASERE LEE OMORUYI
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Credential | BSCE
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Telephone | 281-568-4573
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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 | 010365
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License Number State | TX
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