Provider Demographics
NPI:1023111085
Name:HEALING HEARTS HOME HEALTH AGENCY OF ATASCOCITA, LLC
Entity type:Organization
Organization Name:HEALING HEARTS HOME HEALTH AGENCY OF ATASCOCITA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-360-1331
Mailing Address - Street 1:1000 1ST ST E
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4924
Mailing Address - Country:US
Mailing Address - Phone:281-360-1331
Mailing Address - Fax:281-812-1333
Practice Address - Street 1:1000 1ST ST E
Practice Address - Street 2:SUITE A
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4924
Practice Address - Country:US
Practice Address - Phone:281-360-1331
Practice Address - Fax:281-812-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008687251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170721801Medicaid
TX453148Medicare ID - Type Unspecified