Provider Demographics
NPI:1881974871
Name:IMMACULATE HOME CARE
Entity type:Organization
Organization Name:IMMACULATE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOLUSO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-290-2544
Mailing Address - Street 1:9102 KNIGHTSLAND TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6580
Mailing Address - Country:US
Mailing Address - Phone:832-290-2544
Mailing Address - Fax:
Practice Address - Street 1:9102 KNIGHTSLAND TRL
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6580
Practice Address - Country:US
Practice Address - Phone:832-290-2544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health