Provider Demographics
NPI:1215715115
Name:SHASTA MEDICAL CARE LIMITED
Entity type:Organization
Organization Name:SHASTA MEDICAL CARE LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:VARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:708-261-1477
Mailing Address - Street 1:7110 WANDERING LAKE LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1738
Mailing Address - Country:US
Mailing Address - Phone:708-261-1477
Mailing Address - Fax:
Practice Address - Street 1:7110 WANDERING LAKE LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1738
Practice Address - Country:US
Practice Address - Phone:708-261-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health