Healthcare Provider Details

I. General information

NPI: 1508538075
Provider Name (Legal Business Name): ASTRAL PEDIATRIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21320 PROVINCIAL BLVD
KATY TX
77450-7580
US

IV. Provider business mailing address

5323 MACQUARIE POINT LN
SUGAR LAND TX
77479-4795
US

V. Phone/Fax

Practice location:
  • Phone: 281-595-1454
  • Fax:
Mailing address:
  • Phone: 713-825-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. NKOLI ILOANYA
Title or Position: PRESIDENT
Credential: MD
Phone: 713-825-6297