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General NPI Number Information
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NPI Number | 1427665033
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Entity Type | Organization
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Legal Business Name | KATY LAKES HOME CARE LLC
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 6907 NORTHCHESTER DR
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City | KATY
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State | TX
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Zip | 77493-3850
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Country | US
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Telephone | 832-348-6011
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Fax | 832-557-3422
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Provider Business Mailing Address
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Address Line | 9810 BEACON CROSSING LN
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City | CYPRESS
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State | TX
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Zip | 77433-4001
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Country | US
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Telephone | 832-348-6011
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Fax | 832-557-3422
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HARRIET EVBUOMWAN
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Credential |
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Telephone | 832-348-6011
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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 | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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