Provider Demographics
NPI:1649348640
Name:PAUL'S FARM INC.
Entity type:Organization
Organization Name:PAUL'S FARM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARTOLOME
Authorized Official - Suffix:
Authorized Official - Credentials:DN
Authorized Official - Phone:281-474-2277
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-1064
Mailing Address - Country:US
Mailing Address - Phone:281-474-2277
Mailing Address - Fax:281-474-2287
Practice Address - Street 1:318 WATERFRONT DR STE A
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3923
Practice Address - Country:US
Practice Address - Phone:281-474-2277
Practice Address - Fax:281-474-2287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL'S FARM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1003828251G00000X
TX679333251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000109100Medicaid
TX82888OtherEVERCARE
TX10025075OtherAMERIGROUP
TX1003828Medicaid
TX1003828Medicaid