MEDICARE: PHICO HEALTH CARE 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	251E00000X-HOME HEA-	TX

General Provider Information

NPI Number	:	1790098184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHICO HEALTH CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	7457 HARWIN DRIVE
Second Line	:	SUITE 141
City	:	HOUSTON
State	:	TX
Zip	:	77036
Country	:	US
Telephone Number	:	281-565-0671
Fax Number	:	281-565-7602

Provider Business Practice Location Address
First Line	:	7903 TRABAJO DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-3753
Country	:	US
Telephone Number	:	281-565-0671
Fax Number	:	281-565-7602

Authorized Official
Title or Position	:	ADMINISTRATOR/DIRECTOR
Name	:	JEFF IMOH
Credential	:
Telephone Number	:	281-565-0671

Provider Enumeration Date	:	07/14/2010
Last Update Date	:	05/04/2017

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