MEDICARE: ITS COUNTRY HOME HEALTH, LLC

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	010409	TX

General Provider Information

NPI Number	:	1518054675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITS COUNTRY HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	25003 PITKIN RD STE E100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1494
Country	:	US
Telephone Number	:	713-823-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	25003 PITKIN RD STE E100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1494
Country	:	US
Telephone Number	:	713-823-7066
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR, DON
Name	:	MR. YQUADEA WHITAKER
Credential	:	RN
Telephone Number	:	713-823-7066

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/21/2022

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