Provider Demographics
NPI:1104149335
Name:INDEPENDENT HEALTHCARE SOLUTIONS
Entity type:Organization
Organization Name:INDEPENDENT HEALTHCARE SOLUTIONS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:832-776-0991
Mailing Address - Street 1:11223 CARRIAGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5009
Mailing Address - Country:US
Mailing Address - Phone:832-776-0991
Mailing Address - Fax:
Practice Address - Street 1:11223 CARRIAGE LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5009
Practice Address - Country:US
Practice Address - Phone:832-776-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196092164X00000X, 313M00000X, 320700000X, 251B00000X, 311ZA0620X, 3140N1450X
253J00000X, 315P00000X, 320600000X, 322D00000X, 251J00000X, 251E00000X
196092320900000X, 313M00000X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No253J00000XAgenciesFoster Care Agency
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No251J00000XAgenciesNursing Care