Provider Demographics
NPI:1003061755
Name:MYTOS HOME HEALTH INC
Entity Type:Organization
Organization Name:MYTOS HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLAYEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AJEPE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-886-0309
Mailing Address - Street 1:3806 BROKEN PINE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3366
Mailing Address - Country:US
Mailing Address - Phone:832-886-0309
Mailing Address - Fax:832-886-5160
Practice Address - Street 1:3806 BROKEN PINE CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3366
Practice Address - Country:US
Practice Address - Phone:832-886-0309
Practice Address - Fax:832-886-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012391251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2089708Medicaid
TX747247Medicare PIN