Provider Demographics
NPI:1780165373
Name:ELEANORS CARE PROVIDER SERVICE
Entity type:Organization
Organization Name:ELEANORS CARE PROVIDER SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-978-7211
Mailing Address - Street 1:12615 ARBOR GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-3428
Mailing Address - Country:US
Mailing Address - Phone:832-978-7211
Mailing Address - Fax:
Practice Address - Street 1:12615 ARBOR GARDEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-3428
Practice Address - Country:US
Practice Address - Phone:832-978-7211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX018733251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health