MEDICARE: TOMEKA THOMAS

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1548986607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMEKA THOMAS

Provider Business Mailing Address
First Line	:	11825 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11825 LONGWOOD GARDEN WAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77047-4435
Country	:	US
Telephone Number	:	346-717-1348
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TOMEKA THOMAS
Credential	:
Telephone Number	:	346-717-1348

Provider Enumeration Date	:	10/19/2022
Last Update Date	:	10/19/2022

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