Provider Demographics
NPI:1659587657
Name:ELOHIM HOME HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:ELOHIM HOME HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EZEKIEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:AGBOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:281-238-6333
Mailing Address - Street 1:19719 LARK ORCHARD WAY
Mailing Address - Street 2:LARK ORCHARD WAY
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7117
Mailing Address - Country:US
Mailing Address - Phone:281-238-6333
Mailing Address - Fax:281-232-1818
Practice Address - Street 1:19719 LARK ORCHARD WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-7117
Practice Address - Country:US
Practice Address - Phone:281-238-6333
Practice Address - Fax:281-232-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX011632251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011632OtherDADS