Provider Demographics
NPI:1114949989
Name:IVANA HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:IVANA HOME HEALTH SERVICES, LLC
Other - Org Name:NDSD CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTOO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-208-9600
Mailing Address - Street 1:12808 W AIRPORT BLVD
Mailing Address - Street 2:SUITE 343
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-6184
Mailing Address - Country:US
Mailing Address - Phone:281-212-3442
Mailing Address - Fax:
Practice Address - Street 1:12808 W AIRPORT BLVD
Practice Address - Street 2:SUITE 343
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-6184
Practice Address - Country:US
Practice Address - Phone:281-212-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014765251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677935Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER
TX45D1028175Medicare ID - Type UnspecifiedCLIA WAIVER