Provider Demographics
NPI:1457392698
Name:ANTIOCH HOME HEALTH INC.
Entity type:Organization
Organization Name:ANTIOCH HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:713-663-7131
Mailing Address - Street 1:2420 FANNIN ST STE 1-A
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9114
Mailing Address - Country:US
Mailing Address - Phone:713-663-7131
Mailing Address - Fax:713-663-7205
Practice Address - Street 1:2420 FANNIN ST
Practice Address - Street 2:SUITE 1-A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9114
Practice Address - Country:US
Practice Address - Phone:713-663-7131
Practice Address - Fax:713-663-7205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008211251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679348OtherMEDICARE PROVIDER NUMBER
TX008211OtherHCSSC LICENSE NUMBER
TX008211OtherHCSSC LICENSE NUMBER