=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508131475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVERETT COMMUNITY HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2012
-----------------------------------------------------
Last Update Date | 03/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 MEMORIAL DR SUITE 1109
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77007-8237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-8900
-----------------------------------------------------
Fax | 713-981-8901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5201 MEMORIAL DR SUITE 1109
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77007-8237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-981-8900
-----------------------------------------------------
Fax | 713-981-8901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. AISHE T SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-981-8900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336H0001X
-----------------------------------------------------
Taxonomy Name | Home Infusion Therapy Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------