Provider Demographics
NPI:1629029855
Name:TEAMCARE HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:TEAMCARE HOME HEALTH SERVICES, INC
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IBIM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BOBMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-838-1105
Mailing Address - Street 1:PO BOX 771102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77215-1102
Mailing Address - Country:US
Mailing Address - Phone:713-838-1105
Mailing Address - Fax:713-838-8686
Practice Address - Street 1:2626 S LOOP W
Practice Address - Street 2:562
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:713-838-1105
Practice Address - Fax:713-838-8686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008353251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151968801Medicaid
TX151968801Medicaid