Provider Demographics
NPI:1124014980
Name:STAT HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:STAT HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR D.O.N.
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-520-9997
Mailing Address - Street 1:415 WESTHEIMER RD
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-3047
Mailing Address - Country:US
Mailing Address - Phone:713-520-9997
Mailing Address - Fax:713-520-9996
Practice Address - Street 1:415 WESTHEIMER RD
Practice Address - Street 2:SUITE # 207
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-3047
Practice Address - Country:US
Practice Address - Phone:713-520-9997
Practice Address - Fax:713-520-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX673134251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673134Medicare ID - Type UnspecifiedPROVIDER NUMBER