Provider Demographics
NPI:1285981563
Name:DOMAIN HOME CARE SERVICES
Entity type:Organization
Organization Name:DOMAIN HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:CHIGBO
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-267-6192
Mailing Address - Street 1:9800 BRAEBURN GLEN BLVD
Mailing Address - Street 2:APT 28
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2313
Mailing Address - Country:US
Mailing Address - Phone:832-267-6192
Mailing Address - Fax:
Practice Address - Street 1:9800 BRAEBURN GLEN BLVD
Practice Address - Street 2:APT 28
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2313
Practice Address - Country:US
Practice Address - Phone:832-267-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No282N00000XHospitalsGeneral Acute Care Hospital