Provider Demographics
NPI:1821196973
Name:MARIA REGINA HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:MARIA REGINA HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-494-3456
Mailing Address - Street 1:104 INDUSTRIAL BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-494-3456
Mailing Address - Fax:866-701-0727
Practice Address - Street 1:104 INDUSTRIAL BLVD
Practice Address - Street 2:STE L
Practice Address - City:SUGAR LAD
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-494-3456
Practice Address - Fax:866-701-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009797251E00000X
TX011774251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181513601Medicaid
TX677971Medicare PIN
TX677971Medicare ID - Type UnspecifiedPROVIDER NUMBER