Provider Demographics
NPI:1669788618
Name:PHENOMENAL HEALTHCARE
Entity type:Organization
Organization Name:PHENOMENAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VEITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-815-5409
Mailing Address - Street 1:7234 RIVER PINES DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3226
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:281-815-5409
Practice Address - Street 1:7234 RIVER PINES DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3226
Practice Address - Country:US
Practice Address - Phone:713-385-5513
Practice Address - Fax:281-815-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health