Provider Demographics
NPI:1801893045
Name:PROFESSIONAL NURSES AT HOME, INC.
Entity type:Organization
Organization Name:PROFESSIONAL NURSES AT HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:CARTWRIGHT
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-849-2540
Mailing Address - Street 1:17223 MERCURY DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2733
Mailing Address - Country:US
Mailing Address - Phone:713-849-2540
Mailing Address - Fax:713-849-2570
Practice Address - Street 1:17223 MERCURY DR
Practice Address - Street 2:SUITE #200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2733
Practice Address - Country:US
Practice Address - Phone:713-849-2540
Practice Address - Fax:713-849-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-7590Medicare ID - Type Unspecified