Provider Demographics
NPI:1568619203
Name:VYDELL HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:VYDELL HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRUDENCIA
Authorized Official - Middle Name:MPEH
Authorized Official - Last Name:DEBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-992-1164
Mailing Address - Street 1:9898 BISSONNET ST
Mailing Address - Street 2:SUITE 295
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8270
Mailing Address - Country:US
Mailing Address - Phone:832-363-9696
Mailing Address - Fax:832-582-5029
Practice Address - Street 1:9898 BISSONNET ST
Practice Address - Street 2:SUITE 295
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8270
Practice Address - Country:US
Practice Address - Phone:832-363-9696
Practice Address - Fax:832-582-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6600364Medicaid