Healthcare Provider Details

I. General information

NPI: 1174693816
Provider Name (Legal Business Name): GOLD HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 REGENCY SQUARE BLVD SUITE 221
HOUSTON TX
77036-3138
US

IV. Provider business mailing address

PO BOX 720009
HOUSTON TX
77272-0009
US

V. Phone/Fax

Practice location:
  • Phone: 713-782-8445
  • Fax: 713-268-1148
Mailing address:
  • Phone: 713-782-8445
  • Fax: 713-268-1148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN C EGBUNA
Title or Position: CEO
Credential:
Phone: 713-782-8445