MEDICARE: STAT HOME HEALTH CARE, INC.

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	673134	TX

General Provider Information

NPI Number	:	1124014980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAT HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	415 WESTHEIMER RD
Second Line	:	SUITE # 207
City	:	HOUSTON
State	:	TX
Zip	:	77006-3047
Country	:	US
Telephone Number	:	713-520-9997
Fax Number	:	713-520-9996

Provider Business Practice Location Address
First Line	:	415 WESTHEIMER RD
Second Line	:	SUITE # 207
City	:	HOUSTON
State	:	TX
Zip	:	77006-3047
Country	:	US
Telephone Number	:	713-520-9997
Fax Number	:	713-520-9996

Authorized Official
Title or Position	:	ADMINISTRATOR D.O.N.
Name	:	MR. WILLIAM J CLEVENGER
Credential	:	R.N.
Telephone Number	:	713-520-9997

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	09/10/2007

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