Provider Demographics
NPI:1992291462
Name:PEARL HEALTHCARE, LLC
Entity type:Organization
Organization Name:PEARL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALERO
Authorized Official - Middle Name:OBIANYOR
Authorized Official - Last Name:WATERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:GNP-BC
Authorized Official - Phone:832-722-1618
Mailing Address - Street 1:3733 WESTHEIMER RD STE 1-559
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5271
Mailing Address - Country:US
Mailing Address - Phone:713-955-7374
Mailing Address - Fax:
Practice Address - Street 1:3733 WESTHEIMER RD STE 1-559
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5271
Practice Address - Country:US
Practice Address - Phone:713-955-7374
Practice Address - Fax:702-537-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-07
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
TXAP118306363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3919383Medicaid