Provider Demographics
NPI:1114392248
Name:MEDIEQUIP PATIENT & HOME SERVICES
Entity Type:Organization
Organization Name:MEDIEQUIP PATIENT & HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LDE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-344-0855
Mailing Address - Street 1:3418 HIGHWAY 6 S
Mailing Address - Street 2:B217
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-4206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3418 HIGHWAY 6 S
Practice Address - Street 2:B217
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-4206
Practice Address - Country:US
Practice Address - Phone:713-344-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness