Provider Demographics
NPI:1316944002
Name:ISLAND HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:ISLAND HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RICHARDS
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-749-0085
Mailing Address - Street 1:1908 STATE HIGHWAY 361
Mailing Address - Street 2:
Mailing Address - City:PORT ARANSAS
Mailing Address - State:TX
Mailing Address - Zip Code:78373-4894
Mailing Address - Country:US
Mailing Address - Phone:361-749-0085
Mailing Address - Fax:361-749-2466
Practice Address - Street 1:1908 STATE HIGHWAY 361
Practice Address - Street 2:
Practice Address - City:PORT ARANSAS
Practice Address - State:TX
Practice Address - Zip Code:78373-4894
Practice Address - Country:US
Practice Address - Phone:361-749-0085
Practice Address - Fax:361-749-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008385251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679302Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TX679302Medicare Oscar/Certification