Provider Demographics
NPI:1457482226
Name:EMERALD BLUE HEALTH CARE SERVICES,INC.
Entity Type:Organization
Organization Name:EMERALD BLUE HEALTH CARE SERVICES,INC.
Other - Org Name:MYTOIA MOSS
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MYTOIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:TX HEALTH CARE SERVI
Authorized Official - Phone:713-436-7498
Mailing Address - Street 1:13206 INDIGO CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2548
Mailing Address - Country:US
Mailing Address - Phone:713-436-7498
Mailing Address - Fax:713-436-7610
Practice Address - Street 1:13206 INDIGO CREEK LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2548
Practice Address - Country:US
Practice Address - Phone:713-436-7498
Practice Address - Fax:713-436-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710074299OtherHEALTH CARE SERVICES