Healthcare Provider Details

I. General information

NPI: 1063198208
Provider Name (Legal Business Name): JIVANANI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 POST OAK BLVD STE 4100
HOUSTON TX
77056-6145
US

IV. Provider business mailing address

2800 POST OAK BLVD STE 4100
HOUSTON TX
77056-6145
US

V. Phone/Fax

Practice location:
  • Phone: 832-390-2329
  • Fax:
Mailing address:
  • Phone: 832-390-2329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MS. EMEAKIA S HENSON
Title or Position: OWNER
Credential: CMA &CNA&
Phone: 281-830-7289