MEDICARE: IC- SPRING HOME HEALTH INCORPORATED

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	:	1669766226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IC- SPRING HOME HEALTH INCORPORATED

Provider Business Mailing Address
First Line	:	14405 WALTERS RD STE 835
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1351
Country	:	US
Telephone Number	:	281-895-0050
Fax Number	:	281-895-0090

Provider Business Practice Location Address
First Line	:	14405 WALTERS RD STE 835
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1351
Country	:	US
Telephone Number	:	281-895-0050
Fax Number	:	281-895-0090

Authorized Official
Title or Position	:	OWNER
Name	:	IJEOMA CHRISTIANA AJAYI
Credential	:	RN BSN
Telephone Number	:	281-895-0050

Provider Enumeration Date	:	06/01/2011
Last Update Date	:	08/06/2015

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