Provider Demographics
NPI:1588737712
Name:EL-SHADDAI CARE SERVICES, INC.
Entity type:Organization
Organization Name:EL-SHADDAI CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTH LICENTIAM AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-580-3112
Mailing Address - Street 1:7707 FAWN TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2718
Mailing Address - Country:US
Mailing Address - Phone:713-728-2677
Mailing Address - Fax:713-728-8226
Practice Address - Street 1:7707 FAWN TERRACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2718
Practice Address - Country:US
Practice Address - Phone:713-728-2677
Practice Address - Fax:713-728-8226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007009251E00000X
3747P1801X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003898Medicaid
TX001001143Medicaid