Healthcare Provider Details

I. General information

NPI: 1467606483
Provider Name (Legal Business Name): RICHMOND SA SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19015 S JODI RD STE 11
MOKENA IL
60448-8514
US

IV. Provider business mailing address

7324 SOUTHWEST FREEWAY SUITE 1550
HOUSTON TX
77074-2053
US

V. Phone/Fax

Practice location:
  • Phone: 708-995-5418
  • Fax: 719-988-8402
Mailing address:
  • Phone: 713-779-9800
  • Fax: 713-779-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID P RICHARDSON
Title or Position: CFO
Credential:
Phone: 713-779-9800