Provider Demographics
NPI:1285309211
Name:OUR OWN PROFESSIONAL HOME CARE LLC
Entity type:Organization
Organization Name:OUR OWN PROFESSIONAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-416-3231
Mailing Address - Street 1:2207 HIDDEN EMBERS PATH
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2210
Mailing Address - Country:US
Mailing Address - Phone:281-416-3231
Mailing Address - Fax:
Practice Address - Street 1:2207 HIDDEN EMBERS PATH
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-2210
Practice Address - Country:US
Practice Address - Phone:281-416-3231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-11
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care