Organization
INDEPENDENT CARE
Active
Other names
no
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA A MILLER (INDEPENDENT CARE GIVER)
(361) 554-2640
Entity
Organization
Contact information
Practice address
409 S PUMPHREY ST, APT. 5, EDNA, TX 77957-3240
(361) 554-2640
Mailing address
PO BOX 1292, EDNA, TX 77957-1292
(361) 554-2640
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
530155133
SUPERIOR HEALTH PLAN STAR PLUS
—
05
—
530155133
—
TX
Enumeration date
02/12/2015
Last updated
02/12/2015
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