Provider Demographics
NPI:1609111558
Name:MASTER PEDIATRIC HOME CARE,P.C.
Entity Type:Organization
Organization Name:MASTER PEDIATRIC HOME CARE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:NATHANIEL
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:832-656-7775
Mailing Address - Street 1:10333 HARWIN DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1545
Mailing Address - Country:US
Mailing Address - Phone:713-640-5809
Mailing Address - Fax:
Practice Address - Street 1:10333 HARWIN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1545
Practice Address - Country:US
Practice Address - Phone:713-640-5809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX015378251F00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome InfusionGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty