MEDICARE: AMUDEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1235297912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMUDEK

Provider Business Mailing Address
First Line	:	9138 MARTIN HEIGHTS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-2745
Country	:	US
Telephone Number	:
Fax Number	:	281-394-3760

Provider Business Practice Location Address
First Line	:	9138 MARTIN HEIGHTS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77031-2745
Country	:	US
Telephone Number	:	713-988-0465
Fax Number	:	281-394-3760

Authorized Official
Title or Position	:	CEO
Name	:	MR. OLUSEGUN ADEKUNLE
Credential	:
Telephone Number	:	732-779-2847

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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Directions to “AMUDEK ” Practice Location

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