Provider Demographics
NPI:1962507939
Name:HOME HEALTH AGENCY-HOUSTON, INC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY-HOUSTON, INC
Other - Org Name:OMNI HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:TRACY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-753-4883
Mailing Address - Street 1:12555A GULF FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-4509
Mailing Address - Country:US
Mailing Address - Phone:281-481-2568
Mailing Address - Fax:281-481-2968
Practice Address - Street 1:12555A GULF FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-4509
Practice Address - Country:US
Practice Address - Phone:281-481-2568
Practice Address - Fax:281-481-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011208251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677794Medicare Oscar/Certification