Provider Demographics
NPI:1659402907
Name:ST GREGORY HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ST GREGORY HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-416-9899
Mailing Address - Street 1:3642 YANKEE CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-4819
Mailing Address - Country:US
Mailing Address - Phone:281-416-9899
Mailing Address - Fax:281-416-9337
Practice Address - Street 1:3642 YANKEE CT
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-4819
Practice Address - Country:US
Practice Address - Phone:281-416-9899
Practice Address - Fax:281-416-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011081251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2155657Medicaid
TX747306Medicare UPIN