Provider Demographics
NPI:1447304209
Name:MATTIE'S HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:MATTIE'S HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:512-833-9026
Mailing Address - Street 1:12003 N OAKS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-2314
Mailing Address - Country:US
Mailing Address - Phone:512-833-9026
Mailing Address - Fax:512-719-9028
Practice Address - Street 1:12003 N OAKS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-2314
Practice Address - Country:US
Practice Address - Phone:512-833-9026
Practice Address - Fax:512-719-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10061344Medicaid
TX001014931Medicaid
TXS500295940OtherAMERIGROUP