Provider Demographics
NPI:1710450747
Name:DE LOS ANGELES HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DE LOS ANGELES HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-896-5225
Mailing Address - Street 1:8318 RIVERBEND CANYON LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2592
Mailing Address - Country:US
Mailing Address - Phone:281-896-5225
Mailing Address - Fax:832-416-5987
Practice Address - Street 1:8318 RIVERBEND CANYON LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2592
Practice Address - Country:US
Practice Address - Phone:281-896-5225
Practice Address - Fax:832-416-5987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX426528201Medicaid