MEDICARE: HUMBLE TEXAS HOME CARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	003401	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053317677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBLE TEXAS HOME CARE CORPORATION

Provider Business Mailing Address
First Line	:	101 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4509
Country	:	US
Telephone Number	:	281-540-8773
Fax Number	:	281-540-8743

Provider Business Practice Location Address
First Line	:	101 E HOUSTON ST
Second Line	:
City	:	CLEVELAND
State	:	TX
Zip	:	77327-4509
Country	:	US
Telephone Number	:	281-540-8773
Fax Number	:	281-540-8743

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MS. LAURIE HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/21/2011

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