1699968842 NPI number — MEDPSYCH HOME HEALTHCARE CORPORATION

Table of content: (NPI 1699968842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699968842 NPI number — MEDPSYCH HOME HEALTHCARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDPSYCH HOME HEALTHCARE CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699968842
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24702 PLYMPTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-6131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-693-6700
Provider Business Mailing Address Fax Number:
281-693-6784

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11999 KATY FREEWAY SUITE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-693-6700
Provider Business Practice Location Address Fax Number:
281-693-6784
Provider Enumeration Date:
08/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
281-693-6700

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  011330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 011330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X , with the licence number: 011330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374U00000X , with the licence number: 011330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376G00000X , with the licence number: 011330 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 194394601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011330 . This is a "DADS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 011330 . This is a "HOME HEALTHCARE AGENCY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".