Provider Demographics
NPI:1750769642
Name:ST ANNAS TENDER CARE INC
Entity type:Organization
Organization Name:ST ANNAS TENDER CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENEMUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-983-4882
Mailing Address - Street 1:635 BOLD RULER DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6357
Mailing Address - Country:US
Mailing Address - Phone:832-983-4882
Mailing Address - Fax:713-773-2942
Practice Address - Street 1:11615 CANEMONT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6555
Practice Address - Country:US
Practice Address - Phone:832-983-4882
Practice Address - Fax:713-726-8085
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ANNAS TENDER CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-11
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX01-3678849Medicaid