Healthcare Provider Details

I. General information

NPI: 1558594382
Provider Name (Legal Business Name): OBOSA HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16703 LAZY RIDGE RD
HOUSTON TX
77053-4663
US

IV. Provider business mailing address

16703 LAZY RIDGE RD
HOUSTON TX
77053-4663
US

V. Phone/Fax

Practice location:
  • Phone: 713-429-1873
  • Fax:
Mailing address:
  • Phone: 713-429-1873
  • Fax:

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. PETER OBASOGIE
Title or Position: OWNER
Credential:
Phone: 281-690-1941