Provider Demographics
NPI:1215482070
Name:LARUE HOME HEALTH CARE SERVICE
Entity type:Organization
Organization Name:LARUE HOME HEALTH CARE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KHADERIA
Authorized Official - Middle Name:LAFAYE
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-391-8793
Mailing Address - Street 1:5250 BROWNWAY ST
Mailing Address - Street 2:APT 1916
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4932
Mailing Address - Country:US
Mailing Address - Phone:713-391-8793
Mailing Address - Fax:
Practice Address - Street 1:5250 BROWNWAY ST
Practice Address - Street 2:APT 1916
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4932
Practice Address - Country:US
Practice Address - Phone:713-391-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization