Provider Demographics
NPI:1790913416
Name:HOUSTON EXTRAORDINARY HOME CARE II
Entity Type:Organization
Organization Name:HOUSTON EXTRAORDINARY HOME CARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MAS
Authorized Official - Phone:713-298-5727
Mailing Address - Street 1:9616 BECKLEY ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-4641
Mailing Address - Country:US
Mailing Address - Phone:713-298-5727
Mailing Address - Fax:281-405-9764
Practice Address - Street 1:9616 BECKLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-4641
Practice Address - Country:US
Practice Address - Phone:713-298-5727
Practice Address - Fax:281-405-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126008310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility