Provider Demographics
NPI:1982872503
Name:THE ANTIDOTE HOME HEALTH AND CARE TEAM, LLC
Entity Type:Organization
Organization Name:THE ANTIDOTE HOME HEALTH AND CARE TEAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CITSERICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-431-0124
Mailing Address - Street 1:5403 SILVER CANYON CT
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2146
Mailing Address - Country:US
Mailing Address - Phone:281-431-0124
Mailing Address - Fax:281-710-8724
Practice Address - Street 1:5403 SILVER CANYON CT
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2146
Practice Address - Country:US
Practice Address - Phone:281-431-0124
Practice Address - Fax:281-710-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-16
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194141101Medicaid