Provider Demographics
NPI:1548319288
Name:IMMANUEL HOME HEALTH CARE INC
Entity type:Organization
Organization Name:IMMANUEL HOME HEALTH CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:281-837-1321
Mailing Address - Street 1:606 ROLLINGBROOK
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4053
Mailing Address - Country:US
Mailing Address - Phone:281-837-1321
Mailing Address - Fax:281-428-1461
Practice Address - Street 1:606 ROLLINGBROOK
Practice Address - Street 2:SUITE 2F
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-4053
Practice Address - Country:US
Practice Address - Phone:281-837-1321
Practice Address - Fax:281-428-1461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004433251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004433OtherSTATE LICENSE
TX678499OtherMEDICARE PROVIDER
678499Medicare ID - Type UnspecifiedPROVIDER NUMBER