Provider Demographics
NPI:1508209511
Name:WESTSIDE HOUSTON HOME HEALTHCARE
Entity Type:Organization
Organization Name:WESTSIDE HOUSTON HOME HEALTHCARE
Other - Org Name:WESTSIDE HOUSTON HOME HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LARHONDA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:713-851-9636
Mailing Address - Street 1:6230 W WILLOW BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-8408
Mailing Address - Country:US
Mailing Address - Phone:713-851-9639
Mailing Address - Fax:281-404-9008
Practice Address - Street 1:6230 WEST WILLOW BLUFF RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449
Practice Address - Country:US
Practice Address - Phone:713-851-9639
Practice Address - Fax:281-404-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1488Medicaid