Provider Demographics
NPI:1558752584
Name:INDEPENDENT CARE
Entity Type:Organization
Organization Name:INDEPENDENT CARE
Other - Org Name:NO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INDEPENDENT CARE GIVER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-554-2640
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-1292
Mailing Address - Country:US
Mailing Address - Phone:361-554-2640
Mailing Address - Fax:
Practice Address - Street 1:409 S PUMPHREY ST
Practice Address - Street 2:APT. 5
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-3240
Practice Address - Country:US
Practice Address - Phone:361-554-2640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
530155133OtherSUPERIOR HEALTH PLAN STAR PLUS
TX530155133Medicaid