=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801975263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BREENA MAKEDA - KOBY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2006
-----------------------------------------------------
Last Update Date | 05/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6105 BEVERLYHILL ST STE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-6715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-974-6666
-----------------------------------------------------
Fax | 713-974-6667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6105 BEVERLYHILL ST STE 102
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77057-6715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-974-6666
-----------------------------------------------------
Fax | 713-974-6667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. BREENA I MAKEDA-KOBY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 713-974-6666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010801
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------