Provider Demographics
NPI:1598761132
Name:SELECT CARE HOME HEALTH, INC.
Entity Type:Organization
Organization Name:SELECT CARE HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-370-3500
Mailing Address - Street 1:11803 GRANT RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-4022
Mailing Address - Country:US
Mailing Address - Phone:281-370-3500
Mailing Address - Fax:281-370-3567
Practice Address - Street 1:11803 GRANT RD
Practice Address - Street 2:STE 203
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4022
Practice Address - Country:US
Practice Address - Phone:281-370-3500
Practice Address - Fax:281-370-3567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007966251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-9170Medicare ID - Type Unspecified