Provider Demographics
NPI:1205211216
Name:INTRA HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:INTRA HOME HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-571-0963
Mailing Address - Street 1:10101 FONDREN RD
Mailing Address - Street 2:255
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-4564
Mailing Address - Country:US
Mailing Address - Phone:346-571-0963
Mailing Address - Fax:346-571-0148
Practice Address - Street 1:10101 FONDREN RD
Practice Address - Street 2:255
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-4564
Practice Address - Country:US
Practice Address - Phone:281-899-9338
Practice Address - Fax:281-746-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX017115251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health