MEDICARE: PRIVATE HOME HEALTHCARE,INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QA0600X	Adult Day Care Clinic/Center
2	261QH0100X	Health Service Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	302R00000X	Health Maintenance Organization
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1417221441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVATE HOME HEALTHCARE,INC.

Provider Business Mailing Address
First Line	:	PO BOX 6963
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265-6963
Country	:	US
Telephone Number	:	281-253-4136
Fax Number	:	281-458-0153

Provider Business Practice Location Address
First Line	:	9702 N SAM HOUSTON PKWY E APT 338
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4533
Country	:	US
Telephone Number	:	281-253-4136
Fax Number	:	281-458-0153

Authorized Official
Title or Position	:	CEO
Name	:	CARLA RENEE JACKSON
Credential	:
Telephone Number	:	281-253-4136

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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Directions to “PRIVATE HOME HEALTHCARE,INC. ” Practice Location

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