Healthcare Provider Details

I. General information

NPI: 1568256857
Provider Name (Legal Business Name): CROWN VICTORIA HEALTHCARE SVCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 HAVERFORD COVE CT
RICHMOND TX
77407-1805
US

IV. Provider business mailing address

9211 HAVERFORD COVE CT
RICHMOND TX
77407-1805
US

V. Phone/Fax

Practice location:
  • Phone: 832-382-6568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: JUDITH CHARLES-NWOSU
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-382-6568