Healthcare Provider Details

I. General information

NPI: 1528246360
Provider Name (Legal Business Name): HOUSTON COMMUNITY HEALTH CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 HAHLO ST
HOUSTON TX
77020-3022
US

IV. Provider business mailing address

424 HAHLO ST
HOUSTON TX
77020-3022
US

V. Phone/Fax

Practice location:
  • Phone: 713-674-3326
  • Fax: 713-674-5100
Mailing address:
  • Phone: 713-674-3326
  • Fax: 713-674-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL MOISES MONTEZ
Title or Position: CEO
Credential:
Phone: 713-343-5450