Provider Demographics
NPI:1477228922
Name:MASSALA HOMECARE AGENCY
Entity Type:Organization
Organization Name:MASSALA HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORMOWAH
Authorized Official - Middle Name:MASSALA
Authorized Official - Last Name:JALLAH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:281-224-7190
Mailing Address - Street 1:7600 HIGHMEADOW DR APT 2023
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-4845
Mailing Address - Country:US
Mailing Address - Phone:281-224-7190
Mailing Address - Fax:
Practice Address - Street 1:7600 HIGHMEADOW DR APT 2023
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-4845
Practice Address - Country:US
Practice Address - Phone:281-224-7190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care