=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871602946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIME RELIABLE HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 09/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8323 SOUTHWEST FWY #655
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-779-8861
-----------------------------------------------------
Fax | 713-779-8722
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8323 SOUTHWEST FWY STE 655
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77074-1636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-779-8861
-----------------------------------------------------
Fax | 713-779-8722
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/DON
-----------------------------------------------------
Name | MRS. MERCY MONDAY OKON
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 713-779-8861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 010302
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------