Healthcare Provider Details

I. General information

NPI: 1033568464
Provider Name (Legal Business Name): ESKRIDGE VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 ALLEN PKWY SUITE 200
HOUSTON TX
77019-7100
US

IV. Provider business mailing address

2929 ALLEN PKWY SUITE 200
HOUSTON TX
77019-7100
US

V. Phone/Fax

Practice location:
  • Phone: 314-498-9102
  • Fax:
Mailing address:
  • Phone: 314-498-9102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SARA NICOLE WINBUSH
Title or Position: MANAGER
Credential:
Phone: 314-498-9102