Provider Demographics
NPI:1831266287
Name:HEALTHLINE REHAB & MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:HEALTHLINE REHAB & MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HYACINTH
Authorized Official - Middle Name:MADUEKE
Authorized Official - Last Name:CHIEDU
Authorized Official - Suffix:
Authorized Official - Credentials:CRTT
Authorized Official - Phone:713-694-0051
Mailing Address - Street 1:4615 NORTH FWY STE 204
Mailing Address - Street 2:#204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-2920
Mailing Address - Country:US
Mailing Address - Phone:713-694-0051
Mailing Address - Fax:713-694-4711
Practice Address - Street 1:4615 NORTH FWY STE 204
Practice Address - Street 2:#106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-2920
Practice Address - Country:US
Practice Address - Phone:713-694-0051
Practice Address - Fax:713-694-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0062557332BC3200X
TX007865251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4503610001Medicare ID - Type UnspecifiedMEDICAL SUPPLY(CMS)