Provider Demographics
NPI:1831506310
Name:AT HOME HEALING HANDS LLC
Entity type:Organization
Organization Name:AT HOME HEALING HANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:NATASHA
Authorized Official - Last Name:SHIMPANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-470-1858
Mailing Address - Street 1:8300 FM 1960 RD W STE 450 #4542
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5699
Mailing Address - Country:US
Mailing Address - Phone:832-291-2486
Mailing Address - Fax:
Practice Address - Street 1:8300 FM 1960 RD W STE 450 #4542
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5699
Practice Address - Country:US
Practice Address - Phone:832-291-2486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty