Provider Demographics
NPI:1134371651
Name:PATHFINDER PEDIATRIC HOME CARE, LLC
Entity type:Organization
Organization Name:PATHFINDER PEDIATRIC HOME CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-636-7733
Mailing Address - Street 1:25018 OAKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2722
Mailing Address - Country:US
Mailing Address - Phone:281-364-9695
Mailing Address - Fax:
Practice Address - Street 1:25018 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-2722
Practice Address - Country:US
Practice Address - Phone:281-705-4756
Practice Address - Fax:281-652-5570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012397251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198473401Medicaid
TX198473402Medicaid