Provider Demographics
NPI:1548988348
Name:IMMACULATE CARE
Entity type:Organization
Organization Name:IMMACULATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:CARLA
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-683-8134
Mailing Address - Street 1:2040 GREENHOUSE RD APT 1412
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7812
Mailing Address - Country:US
Mailing Address - Phone:832-683-8134
Mailing Address - Fax:
Practice Address - Street 1:2040 GREENHOUSE RD APT 1412
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7812
Practice Address - Country:US
Practice Address - Phone:832-683-8134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)