Provider Demographics
NPI:1568654762
Name:HOLISTIC HOME CARE NURSING, INC.
Entity Type:Organization
Organization Name:HOLISTIC HOME CARE NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEWELLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGAROO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-956-9841
Mailing Address - Street 1:5005 W 34TH ST STE 104B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-6741
Mailing Address - Country:US
Mailing Address - Phone:713-956-9841
Mailing Address - Fax:713-956-9843
Practice Address - Street 1:5005 W 34TH ST STE 104B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-6741
Practice Address - Country:US
Practice Address - Phone:713-956-9841
Practice Address - Fax:713-956-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003266251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000126600Medicaid
TX10021505Medicaid
TX000959500Medicaid
TX001004337Medicaid