Provider Demographics
NPI:1033713698
Name:VON ELIJAH HOME HEALTH CARE
Entity Type:Organization
Organization Name:VON ELIJAH HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEEON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-212-4005
Mailing Address - Street 1:9718 CANE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-2002
Mailing Address - Country:US
Mailing Address - Phone:832-212-4005
Mailing Address - Fax:
Practice Address - Street 1:9718 CANE CREEK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2002
Practice Address - Country:US
Practice Address - Phone:832-212-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01OtherPURSUING DADS LICENSE