Healthcare Provider Details

I. General information

NPI: 1427672047
Provider Name (Legal Business Name): 5203 CREST RIDGE DRIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 WEST ROAD
HOUSTON TX
77064
US

IV. Provider business mailing address

10419 CUTTING HORSE LN
HOUSTON TX
77064-7101
US

V. Phone/Fax

Practice location:
  • Phone: 470-363-0392
  • Fax:
Mailing address:
  • Phone: 404-992-1941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MUZBAU ADEEYO
Title or Position: PRESIDENT
Credential:
Phone: 470-363-0392