MEDICARE: MESOTINA HEALTHCARE PROFESSIONAL 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	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871224824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESOTINA HEALTHCARE PROFESSIONAL LLC

Provider Business Mailing Address
First Line	:	8704 TORCELLO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1143
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8704 TORCELLO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-1143
Country	:	US
Telephone Number	:	713-820-5205
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EKOMOBONG EDUOK
Credential	:	RN
Telephone Number	:	713-820-5205

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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