Provider Demographics
NPI:1720516321
Name:MYFAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MYFAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:G
Authorized Official - Last Name:DELA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-742-8621
Mailing Address - Street 1:10707 CORPORATE DR STE 140
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4092
Mailing Address - Country:US
Mailing Address - Phone:832-742-8621
Mailing Address - Fax:346-240-3857
Practice Address - Street 1:10707 CORPORATE DR STE 140
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4092
Practice Address - Country:US
Practice Address - Phone:832-742-8621
Practice Address - Fax:346-240-3857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018304OtherTX DADS LICENSE
TX3790404Medicaid