Provider Demographics
NPI:1255906020
Name:EXQUISITE QUEENS IN-HOME CARE, LLC
Entity type:Organization
Organization Name:EXQUISITE QUEENS IN-HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-653-2468
Mailing Address - Street 1:14211 EVENTIDE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3907
Mailing Address - Country:US
Mailing Address - Phone:281-653-2468
Mailing Address - Fax:832-213-2412
Practice Address - Street 1:14211 EVENTIDE DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-3907
Practice Address - Country:US
Practice Address - Phone:281-653-2468
Practice Address - Fax:832-213-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019216OtherHHSC
TX1255906020OtherNPI
TX001031899Medicaid
TX3982175-01OtherTEXAS PROVIDER IDENTIFIER