Provider Demographics
NPI:1225363591
Name:LAKE HOUSTON HOME HEALTH SERVICES, PLLC
Entity Type:Organization
Organization Name:LAKE HOUSTON HOME HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-324-4663
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-1446
Mailing Address - Country:US
Mailing Address - Phone:281-324-4663
Mailing Address - Fax:281-324-2795
Practice Address - Street 1:12238 FM 1960
Practice Address - Street 2:
Practice Address - City:HUFFMAN
Practice Address - State:TX
Practice Address - Zip Code:77336-4665
Practice Address - Country:US
Practice Address - Phone:281-324-4663
Practice Address - Fax:281-324-2795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013046251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217660401Medicaid
TX747437Medicare PIN