Provider Demographics
NPI:1417221441
Name:PRIVATE HOME HEALTHCARE,INC.
Entity Type:Organization
Organization Name:PRIVATE HOME HEALTHCARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-253-4136
Mailing Address - Street 1:PO BOX 6963
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77265-6963
Mailing Address - Country:US
Mailing Address - Phone:281-253-4136
Mailing Address - Fax:281-458-0153
Practice Address - Street 1:9702 N SAM HOUSTON PKWY E APT 338
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4533
Practice Address - Country:US
Practice Address - Phone:281-253-4136
Practice Address - Fax:281-458-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization