Provider Demographics
NPI:1730105438
Name:HOME HEALTH CARE OF HUNTSVILLE, CO.
Entity Type:Organization
Organization Name:HOME HEALTH CARE OF HUNTSVILLE, CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,
Authorized Official - Phone:936-291-8439
Mailing Address - Street 1:PO BOX 6548
Mailing Address - Street 2:2505 LAKE RD STE 2
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77342-6548
Mailing Address - Country:US
Mailing Address - Phone:936-291-8439
Mailing Address - Fax:936-291-8582
Practice Address - Street 1:2505 LAKE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340
Practice Address - Country:US
Practice Address - Phone:936-291-8439
Practice Address - Fax:936-291-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX001674251E00000X
TX002485251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
000210100OtherHOSPICE MEDICAID
679340Medicare Oscar/Certification
TX451574Medicare Oscar/Certification