Provider Demographics
NPI:1609018712
Name:SRMC CENTER HOME HEALTH LLC
Entity Type:Organization
Organization Name:SRMC CENTER HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMAN
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:254-694-4428
Mailing Address - Street 1:200 N SAN JACINTO ST
Mailing Address - Street 2:P.O. BOX 1629
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2388
Mailing Address - Country:US
Mailing Address - Phone:254-694-4428
Mailing Address - Fax:254-694-0280
Practice Address - Street 1:200 N SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2388
Practice Address - Country:US
Practice Address - Phone:254-694-4428
Practice Address - Fax:254-694-0280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health