Provider Demographics
NPI:1699968842
Name:MEDPSYCH HOME HEALTHCARE CORPORATION
Entity type:Organization
Organization Name:MEDPSYCH HOME HEALTHCARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-693-6700
Mailing Address - Street 1:24702 PLYMPTON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6131
Mailing Address - Country:US
Mailing Address - Phone:281-693-6700
Mailing Address - Fax:281-693-6784
Practice Address - Street 1:11999 KATY FREEWAY SUITE 225
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079
Practice Address - Country:US
Practice Address - Phone:281-693-6700
Practice Address - Fax:281-693-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011330163WH0200X, 251E00000X, 3747A0650X, 374U00000X, 376G00000X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194394601Medicaid
TX011330OtherDADS
TX011330OtherHOME HEALTHCARE AGENCY
TX747364Medicare Oscar/Certification