1851579106 NPI number — HEALS HEALTHCARE SERVICES, LLC

Table of content: (NPI 1851579106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851579106 NPI number — HEALS HEALTHCARE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALS HEALTHCARE SERVICES, LLC
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:
FATE HOME HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1851579106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19815 BLACK CANYON 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:
77450-8739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-891-4762
Provider Business Mailing Address Fax Number:
281-657-7008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19815 BLACK CANYON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77450-8739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-891-4762
Provider Business Practice Location Address Fax Number:
281-657-7008
Provider Enumeration Date:
02/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
IFANSE
Authorized Official First Name:
SOLOMON
Authorized Official Middle Name:
EGANMIDAYO
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-636-9800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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)





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