1821196973 NPI number — MARIA REGINA HOME HEALTH AGENCY INC

Table of content: (NPI 1821196973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821196973 NPI number — MARIA REGINA HOME HEALTH AGENCY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA REGINA HOME HEALTH AGENCY INC
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:
1821196973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
STE L
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-494-3456
Provider Business Mailing Address Fax Number:
866-701-0727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 INDUSTRIAL BLVD
Provider Second Line Business Practice Location Address:
STE L
Provider Business Practice Location Address City Name:
SUGAR LAD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-494-3456
Provider Business Practice Location Address Fax Number:
866-701-0727
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAMUELS
Authorized Official First Name:
RUBY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-494-3456

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  009797 , 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: 011774 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 181513601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".