MEDICARE: NICOLEST HEALTHCARE SERVICES 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

General Provider Information

NPI Number	:	1497092589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLEST HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	18446 AUSTIN OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2276
Country	:	US
Telephone Number	:	713-459-1705
Fax Number	:

Provider Business Practice Location Address
First Line	:	18446 AUSTIN OAK LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-2276
Country	:	US
Telephone Number	:	713-459-1705
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EDWINA DOUGLAS
Credential	:
Telephone Number	:	713-459-1705

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	01/09/2013

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