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General NPI Number Information
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NPI Number | 1508911629
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Entity Type | Organization
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Legal Business Name | NORTHEAST NSG. SVCS. PHC HMO INC
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 6643 W MONTGOMERY RD NA
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City | HOUSTON
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State | TX
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Zip | 77091-3103
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Country | US
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Telephone | 713-964-2742
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Fax | 713-862-4010
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Provider Business Mailing Address
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Address Line | PO BOX 16236
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City | HOUSTON
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State | TX
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Zip | 77222-6236
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Country | US
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Telephone | 713-694-2742
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Fax | 713-862-4010
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PROF. VIVIAN D. GARNER
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Credential | R.N.
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Telephone | 713-694-2742
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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 | 007149
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License Number State | TX
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