Provider Demographics
NPI:1508911629
Name:NORTHEAST NSG. SVCS. PHC HMO INC
Entity Type:Organization
Organization Name:NORTHEAST NSG. SVCS. PHC HMO INC
Other - Org Name:NORTHEAST NSG.SVCS. PHC HMO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-694-2742
Mailing Address - Street 1:PO BOX 16236
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77222-6236
Mailing Address - Country:US
Mailing Address - Phone:713-694-2742
Mailing Address - Fax:713-862-4010
Practice Address - Street 1:6643 W MONTGOMERY RD
Practice Address - Street 2:NA
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-3103
Practice Address - Country:US
Practice Address - Phone:713-964-2742
Practice Address - Fax:713-862-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007149251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health