Provider Demographics
NPI:1407606007
Name:HERNDON, QUENYATTA (LLC)
Entity Type:Individual
Prefix:
First Name:QUENYATTA
Middle Name:
Last Name:HERNDON
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:QUENYATTA
Other - Middle Name:
Other - Last Name:HERNDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 HOLLOW TREE LN APT 2084
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1723
Mailing Address - Country:US
Mailing Address - Phone:832-484-2247
Mailing Address - Fax:
Practice Address - Street 1:100 HOLLOW TREE LN APT 2084
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1723
Practice Address - Country:US
Practice Address - Phone:832-484-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No374U00000XNursing Service Related ProvidersHome Health Aide