MEDICARE: ADEWOLE BEHAVIORAL HEALTH SERVICES

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1801610241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADEWOLE BEHAVIORAL HEALTH SERVICES

Provider Business Mailing Address
First Line	:	13223 ELDRIDGE CHASE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-1757
Country	:	US
Telephone Number	:	346-529-7822
Fax Number	:

Provider Business Practice Location Address
First Line	:	13223 ELDRIDGE CHASE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-1757
Country	:	US
Telephone Number	:	346-529-7822
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. JERONE BRACEY
Credential	:
Telephone Number	:	346-529-7822

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	12/25/2024

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