Provider Demographics
NPI:1932201514
Name:ULTIMATE PEDIATRIC CARE, INC.
Entity Type:Organization
Organization Name:ULTIMATE PEDIATRIC CARE, INC.
Other - Org Name:DYNAMIC HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIMS-THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-271-9010
Mailing Address - Street 1:8313 SOUTHWEST FWY
Mailing Address - Street 2:SUITE # 239
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1518
Mailing Address - Country:US
Mailing Address - Phone:713-271-9010
Mailing Address - Fax:713-271-0843
Practice Address - Street 1:8313 SOUTHWEST FWY
Practice Address - Street 2:SUITE # 239
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1611
Practice Address - Country:US
Practice Address - Phone:713-271-9010
Practice Address - Fax:713-271-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008232251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024394101Medicaid
TX001004810OtherPHC
TX001004810OtherPHC