Provider Demographics
NPI:1215352570
Name:INTRACARE INFUSION, LLC
Entity type:Organization
Organization Name:INTRACARE INFUSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-349-9221
Mailing Address - Street 1:5909 WEST LOOP S
Mailing Address - Street 2:SUITE 675
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2402
Mailing Address - Country:US
Mailing Address - Phone:713-349-9221
Mailing Address - Fax:713-349-9251
Practice Address - Street 1:5909 WEST LOOP S
Practice Address - Street 2:SUITE 675
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2402
Practice Address - Country:US
Practice Address - Phone:713-349-9221
Practice Address - Fax:713-349-9251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty