Provider Demographics
NPI:1962972133
Name:ST MARY'S HOME HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:ST MARY'S HOME HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:OBIAGELI
Authorized Official - Last Name:NWANKWOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-596-5299
Mailing Address - Street 1:819 DRACENA CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2857
Mailing Address - Country:US
Mailing Address - Phone:561-596-5299
Mailing Address - Fax:281-670-5042
Practice Address - Street 1:819 DRACENA CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2857
Practice Address - Country:US
Practice Address - Phone:561-596-5299
Practice Address - Fax:281-670-5042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health