Healthcare Provider Details

I. General information

NPI: 1508944729
Provider Name (Legal Business Name): KOTUN KEHINDE A & ABORISADE TAIWO M
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 FALLSVIEW LN APT 821
HOUSTON TX
77077-3608
US

IV. Provider business mailing address

13131 FALLSVIEW LN APT 821
HOUSTON TX
77077-3608
US

V. Phone/Fax

Practice location:
  • Phone: 281-759-5967
  • Fax: 281-759-5967
Mailing address:
  • Phone: 281-759-5967
  • Fax: 281-759-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TAIWO MOPELOLA ABORISADE
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 281-759-5967