Healthcare Provider Details

I. General information

NPI: 1205201324
Provider Name (Legal Business Name): CENTER FOR PROFESSIONAL DEVLOPMENT & HEALTHCARE SERIVES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8506 OLD BROOK DR
HOUSTON TX
77071-2442
US

IV. Provider business mailing address

PO BOX 300889
HOUSTON TX
77230-0889
US

V. Phone/Fax

Practice location:
  • Phone: 832-306-9519
  • Fax: 713-270-7396
Mailing address:
  • Phone: 832-306-9519
  • Fax: 713-270-7396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4015
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number4015
License Number StateTX

VIII. Authorized Official

Name: DR. BEKEE NWAKANMA
Title or Position: ADMINISTRATOR / CEO
Credential: LCDC,LNFA,MPA,EDD
Phone: 832-306-9519