Healthcare Provider Details

I. General information

NPI: 1689962508
Provider Name (Legal Business Name): CITY CROWN PHP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 RAVEN FALLS LN
FRIENDSWOOD TX
77546-6072
US

IV. Provider business mailing address

2626 RAVEN FALLS LN
FRIENDSWOOD TX
77546-6072
US

V. Phone/Fax

Practice location:
  • Phone: 832-326-9028
  • Fax: 281-992-2187
Mailing address:
  • Phone: 832-326-9028
  • Fax: 281-992-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. VERONICA UZOAMAKA OKAFOR
Title or Position: CEO
Credential:
Phone: 832-326-9028