Provider Demographics
NPI:1053869727
Name:1ST TRADITIONS HOMECARE, LLC
Entity type:Organization
Organization Name:1ST TRADITIONS HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GAETAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DJOUFFO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-416-0409
Mailing Address - Street 1:922 HOLLY CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9896 BISSONNET ST
Practice Address - Street 2:SUITE 380
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8104
Practice Address - Country:US
Practice Address - Phone:713-416-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management