Provider Demographics
NPI:1295243145
Name:WHOLESOME HOME HEALTH,LLC
Entity type:Organization
Organization Name:WHOLESOME HOME HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-888-8359
Mailing Address - Street 1:2217 HOLLISTER ST APT 503
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-6017
Mailing Address - Country:US
Mailing Address - Phone:832-888-8359
Mailing Address - Fax:
Practice Address - Street 1:7011 HARWIN DR STE 224
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2133
Practice Address - Country:US
Practice Address - Phone:281-888-9611
Practice Address - Fax:832-888-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid