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General NPI Number Information
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NPI Number | 1457036972
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Entity Type | Organization
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Legal Business Name | VISTACARE PROVIDER SERVICES INC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 5006 HEARTH HOLLOW LN
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City | SUGAR LAND
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State | TX
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Zip | 77479-3857
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Country | US
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Telephone | 832-443-3705
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Fax |
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Provider Business Mailing Address
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Address Line | 5006 HEARTH HOLLOW LN
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City | SUGAR LAND
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State | TX
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Zip | 77479-3857
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NKECHI EGBOSIMBA
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Credential |
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Telephone | 832-443-3705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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