Provider Demographics
NPI:1417290222
Name:MICHELLE HOME
Entity Type:Organization
Organization Name:MICHELLE HOME
Other - Org Name:MICHELLE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:CHUCKS
Authorized Official - Last Name:MORDI
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:713-518-6212
Mailing Address - Street 1:15907 TAMMANY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2936
Mailing Address - Country:US
Mailing Address - Phone:713-518-6212
Mailing Address - Fax:
Practice Address - Street 1:15907 TAMMANY LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2936
Practice Address - Country:US
Practice Address - Phone:713-518-6212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health