Provider Demographics
NPI:1396027397
Name:MYSTIC ROSE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:MYSTIC ROSE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANETTIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-874-4325
Mailing Address - Street 1:508 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-3010
Mailing Address - Country:US
Mailing Address - Phone:903-874-4325
Mailing Address - Fax:903-874-9140
Practice Address - Street 1:508 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-3010
Practice Address - Country:US
Practice Address - Phone:903-874-4325
Practice Address - Fax:903-874-9140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYSTIC ROSE SOCIAL SERVICE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health