Provider Demographics
NPI:1891189882
Name:T&D HEAVENLY HOME HEALTHCARE INC
Entity Type:Organization
Organization Name:T&D HEAVENLY HOME HEALTHCARE INC
Other - Org Name:T&D HEAVENLY HOME HEALTHCARE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THERALL
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-965-3630
Mailing Address - Street 1:6101 PINEMONT DR STE G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-3212
Mailing Address - Country:US
Mailing Address - Phone:281-965-3630
Mailing Address - Fax:281-947-3120
Practice Address - Street 1:6101 PINEMONT DR STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-3212
Practice Address - Country:US
Practice Address - Phone:281-965-3630
Practice Address - Fax:281-947-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384738602Medicaid