Healthcare Provider Details

I. General information

NPI: 1023035110
Provider Name (Legal Business Name): PHAN HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14601 BELLAIRE BLVD STE 45
HOUSTON TX
77083-2544
US

IV. Provider business mailing address

14601 BELLAIRE BLVD STE 45
HOUSTON TX
77083-2544
US

V. Phone/Fax

Practice location:
  • Phone: 281-564-3473
  • Fax: 281-564-3475
Mailing address:
  • Phone:
  • Fax: 281-564-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number086Q
License Number StateTX

VIII. Authorized Official

Name: VICTOR ONWUMERE
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 281-564-3473