Healthcare Provider Details

I. General information

NPI: 1689439358
Provider Name (Legal Business Name): HEPHZIBAH HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 WINDY GROVE DR
TEXAS CITY TX
77568-1326
US

IV. Provider business mailing address

2401 FOUNTAIN VIEW DR # 2023
HOUSTON TX
77057-4827
US

V. Phone/Fax

Practice location:
  • Phone: 857-312-5831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: OLUWASEUN ASERE
Title or Position: DIRECTOR
Credential:
Phone: 409-292-3132