MEDICARE: COORDINATING CARE CENTER

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	253Z00000X	In Home Supportive Care Agency		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	:	1144697681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COORDINATING CARE CENTER

Provider Business Mailing Address
First Line	:	9816 MEMORIAL BLVD STE 105
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4205
Country	:	US
Telephone Number	:	281-446-0061
Fax Number	:

Provider Business Practice Location Address
First Line	:	9816 MEMORIAL BLVD STE 105
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77338-4205
Country	:	US
Telephone Number	:	281-446-0061
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	GLENDADALE ADAMS
Credential	:
Telephone Number	:	281-446-0061

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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Directions to “COORDINATING CARE CENTER ” Practice Location

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