Provider Demographics
NPI:1144786310
Name:MODERN HOMECARE, LLC
Entity Type:Organization
Organization Name:MODERN HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-501-0350
Mailing Address - Street 1:PO BOX 940691
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-7691
Mailing Address - Country:US
Mailing Address - Phone:281-501-0350
Mailing Address - Fax:888-891-6316
Practice Address - Street 1:10777 WESTHEIMER RD STE 1100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-3462
Practice Address - Country:US
Practice Address - Phone:281-501-0350
Practice Address - Fax:888-891-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-13
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health