Provider Demographics
NPI:1497162630
Name:365CARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:365CARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-548-0036
Mailing Address - Street 1:4090 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-5226
Mailing Address - Country:US
Mailing Address - Phone:409-548-0036
Mailing Address - Fax:409-548-0071
Practice Address - Street 1:4090 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-5226
Practice Address - Country:US
Practice Address - Phone:409-548-0036
Practice Address - Fax:409-548-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016511251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747976Medicare Oscar/Certification