Healthcare Provider Details

I. General information

NPI: 1235297912
Provider Name (Legal Business Name): AMUDEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9138 MARTIN HEIGHTS DR
HOUSTON TX
77031-2745
US

IV. Provider business mailing address

9138 MARTIN HEIGHTS DR
HOUSTON TX
77031-2745
US

V. Phone/Fax

Practice location:
  • Phone: 713-988-0465
  • Fax: 281-394-3760
Mailing address:
  • Phone:
  • Fax: 281-394-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. OLUSEGUN ADEKUNLE
Title or Position: CEO
Credential:
Phone: 732-779-2847