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General NPI Number Information
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NPI Number | 1225808686
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Entity Type | Organization
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Legal Business Name | CSJ PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 7011 HARWIN DR STE 196
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City | HOUSTON
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State | TX
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Zip | 77036-2121
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Country | US
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Telephone | 713-242-8167
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Fax | 832-802-6648
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Provider Business Mailing Address
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Address Line | 7011 HARWIN DR STE 196
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City | HOUSTON
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State | TX
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Zip | 77036-2121
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Country | US
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Telephone | 713-242-8167
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MR. WENENDA SHAWN OKENDU
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Credential |
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Telephone | 832-591-6836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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