Provider Demographics
NPI:1376705004
Name:HOLINESS HOME HEALTHCARE CORP
Entity Type:Organization
Organization Name:HOLINESS HOME HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:713-589-6416
Mailing Address - Street 1:24131 SEVENTH HEAVEN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0177
Mailing Address - Country:US
Mailing Address - Phone:713-589-6416
Mailing Address - Fax:713-429-0463
Practice Address - Street 1:24131 SEVENTH HEAVEN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0177
Practice Address - Country:US
Practice Address - Phone:713-589-6416
Practice Address - Fax:713-429-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747137Medicare PIN