Provider Demographics
NPI:1972820140
Name:PEDIATRIC IMPRESSIONS HOME HEALTH INC
Entity type:Organization
Organization Name:PEDIATRIC IMPRESSIONS HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IFY
Authorized Official - Middle Name:CECILIA
Authorized Official - Last Name:AGBO
Authorized Official - Suffix:
Authorized Official - Credentials:BA HONORS/ LVN
Authorized Official - Phone:281-954-2554
Mailing Address - Street 1:8700 COMMERCE PARK DR STE 146
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7432
Mailing Address - Country:US
Mailing Address - Phone:281-954-2554
Mailing Address - Fax:713-636-3338
Practice Address - Street 1:8700 COMMERCE PARK DRIVE STE. 146
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7432
Practice Address - Country:US
Practice Address - Phone:281-954-2554
Practice Address - Fax:713-636-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health