Provider Demographics
NPI:1396070314
Name:DE HEALTH LINE LLC
Entity type:Organization
Organization Name:DE HEALTH LINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGBUCHUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:713-541-6000
Mailing Address - Street 1:PO BOX 571854
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77257-1854
Mailing Address - Country:US
Mailing Address - Phone:713-541-6000
Mailing Address - Fax:713-541-6001
Practice Address - Street 1:11711 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1335
Practice Address - Country:US
Practice Address - Phone:713-541-6000
Practice Address - Fax:713-541-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX266013336H0001X, 3336S0011X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI-352923201Medicaid