=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962646406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY HEALTHCARE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2009
-----------------------------------------------------
Last Update Date | 12/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13111 WESTHEIMER RD SUITE 121
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77077-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-4000
-----------------------------------------------------
Fax | 713-541-4002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13111 WESTHEIMER RD STE 121-A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77077-5546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-4000
-----------------------------------------------------
Fax | 713-541-4002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. ROXANA VELAZQUEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-541-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 016619
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------